Development of a new stroke scale in an emergency setting

Mao, Haifeng; Pan, Lin; Mo, Junrong; Li, Yunmei; Chen, Xiaohui; Rainer, Timothy; Jiang, Hangjin

doi:10.1186/s12883-016-0695-z

Cited by 16 publications

(13 citation statements)

References 35 publications

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“…In 13/25 (52%) papers it was not specifically mentioned or was judged to be unclear whether the results of clinical assessment (the index test) were interpreted independently from those tests that were used to make a final diagnosis (the reference test) [7,8,[17][18][19][9][10][11][12][13][14][15][16].…”

Section: Risk Of Bias Assessment In Individual Studiesmentioning

confidence: 99%

Diagnostic accuracy of clinical tools for assessment of acute stroke: a systematic review

Antipova

Eadie

Macaden

et al. 2019

Preprint

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Introduction: Recanalisation therapy in acute ischaemic stroke is highly time-sensitive, and requires early identification of eligible patients to ensure better outcomes. Thus, a number of clinical assessment tools have been developed and this review examines their diagnostic capabilities. Methods: Diagnostic performance of currently available clinical tools for identification of acute ischaemic and haemorrhagic strokes and stroke mimicking conditions was reviewed. A systematic search of the literature published in 2015-2018 was conducted using PubMed, EMBASE, Scopus and The Cochrane Library. Prehospital and in-hospital studies with a minimum sample size of 300 patients reporting diagnostic accuracy were selected. Results: Twenty-five articles were included. Cortical signs (gaze deviation, aphasia and neglect) were shown to be significant indicators of large vessel occlusion (LVO). Sensitivity values for selecting subjects with LVO ranged from 23% to 99% whereas specificity was 24% to 97%. Clinical tools, such as FAST-ED, NIHSS, and RACE incorporating cortical signs as well as motor dysfunction demonstrated the best diagnostic accuracy. Tools for identification of stroke mimics showed sensitivity varying from 44% to 91%, and specificity of 27% to 98% with the best diagnostic performance demonstrated by FABS (90% sensitivity, 91% specificity). Hypertension and younger age predicted intracerebral haemorrhage whereas history of atrial fibrillation and diabetes were associated with ischaemia. There was a variation in approach used to establish the definitive diagnosis. Blinding of the index test assessment was not specified in about 50% of included studies. Conclusions: A wide range of clinical assessment tools for selecting subjects with acute stroke has been developed in recent years. Assessment of both cortical and motor function using RACE, FAST-ED and NIHSS showed the best diagnostic accuracy values for selecting subjects with LVO. There were limited data on clinical tools that can be used to differentiate between acute ischaemia and haemorrhage. Diagnostic accuracy appeared to be modest for distinguishing between acute stroke and stroke mimics with optimal diagnostic performance demonstrated by the FABS tool. Further prehospital research is required to improve the diagnostic utility of clinical assessments with possible application of a two-step clinical assessment or involvement of simple brain imaging, such as transcranial ultrasonography.

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Section: Risk Of Bias Assessment In Individual Studiesmentioning

confidence: 99%

Diagnostic accuracy of clinical tools for assessment of acute stroke: a systematic review

Antipova

Eadie

Macaden

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…In 13/25 (52%) papers it was not specifically mentioned or was judged to be unclear whether the results of clinical assessment (the index test) were interpreted independently from those tests that were used to make a final diagnosis (the reference test) [7][8][9][10][11][12][13][14][15][16][17][18][19].…”

Section: Risk Of Bias Assessment In Individual Studiesmentioning

confidence: 99%

Diagnostic accuracy of clinical tools for assessment of acute stroke: a systematic review

Antipova

Eadie

Macaden

et al. 2019

Preprint

View full text Add to dashboard Cite

Introduction Recanalisation therapy in acute ischaemic stroke is highly time-sensitive, and requires early identification of eligible patients to ensure better outcomes. Thus, a number of clinical assessment tools have been developed and this review examines their diagnostic capabilities. Methods Diagnostic performance of currently available clinical tools for identification of acute ischaemic and haemorrhagic strokes and stroke mimicking conditions was reviewed. A systematic search of the literature published in 2015-2018 was conducted using PubMed, EMBASE, Scopus and The Cochrane Library. Prehospital and in-hospital studies with a minimum sample size of 300 patients reporting diagnostic accuracy were selected. Results Twenty-five articles were included. Cortical signs (gaze deviation, aphasia and neglect) were shown to be significant indicators of large vessel occlusion (LVO). Sensitivity values for selecting subjects with LVO ranged from 23% to 99% whereas specificity was 24% to 97%. Clinical tools, such as FAST-ED, NIHSS, and RACE incorporating cortical signs as well as motor dysfunction demonstrated the best diagnostic accuracy. Tools for identification of stroke mimics showed sensitivity varying from 44% to 91%, and specificity of 27% to 98% with the best diagnostic performance demonstrated by FABS (90% sensitivity, 91% specificity). Hypertension and younger age predicted intracerebral haemorrhage whereas history of atrial fibrillation and diabetes were associated with ischaemia. There was a variation in approach used to establish the definitive diagnosis. Blinding of the index test assessment was not specified in about 50% of included studies. Conclusions A wide range of clinical assessment tools for selecting subjects with acute stroke has been developed in recent years. Assessment of both cortical and motor function using RACE, FAST-ED and NIHSS showed the best diagnostic accuracy values for selecting subjects with LVO. There were limited data on clinical tools that can be used to differentiate between acute ischaemia and haemorrhage. Diagnostic accuracy appeared to be modest for distinguishing between acute stroke and stroke mimics with optimal diagnostic performance demonstrated by the FABS tool. Further prehospital research is required to improve the diagnostic utility of clinical assessments with possible application of a two-step clinical assessment or involvement of simple brain imaging, such as transcranial ultrasonography.

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“…Penelitian Mao et al (2016) menunjukkan bahwa dikembangkan assessment baru untuk mengidentifikasi pasien yang di curigai stroke di IGD yang mempunyai 9 parameter antara lain vertigo (-1), GCS  8 (+2), kelemahan otot wajah (+1), kelemahan tangan (+1), kelemahan kaki (+1), kesulitan berbicara (+0.5), gangguan penglihatan (+1), SDP 145 mmHg (+1) dan DBP 95 mmHg (+1). Instrumen pengkajianini mempunyai nilai diskriminasi yang kuat (0,87) dibandingkan ROSIER (0,772), LAPSS (0,722) Batmanian et al (2007) menyebutkan apabila ada pasien yang dicurigai stroke datang ke instalasi gawat darurat maka akan dilakukan triage secara cepat dengan kategori ATS prioritas 2 dalam waktu kurang dari 10 menit.…”

Section: Hasil Penelitianunclassified

“…Selain itu juga disebabkan oleh adanya perbedaan genetik, klinis, lingkungan dan faktor gaya hidup. Mao et al (2016) yang membuat instrumen baru untuk assessment pasien Tionghoa yang dicurigai stroke di instalasi gawat darurat menunjukkan bahwa GZSS(Guangzhou Stroke Scale) mempunyai sensitifitas yang lebih baik untuk mendiagnosis pasien Tionghoa yang dicurigai stroke sehingga efektif membedakan stroke akut atau bukan stroke.…”

Section: Pembahasanunclassified

Peran Perawat dalam Assessment Pengenalan Dini untuk Meningkatkan Outcome Pasien Stroke di Instalasi Gawat Darurat

Rachmawati¹

2019

JNK

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Stroke penyakit kegawat daruratan medis yang sangat tergantung waktu dalam penanganannya. Assessment menentukan diagnosis stroke adalah kunci pokok manajemen stroke. Tujuan literature ini mengatahui bagaimana peran perawat dalam assessment untuk meningkatkan outcome pasien stroke. Metode literature review adalah mengumpulkan dan analisa artikel tentang assessment, diagnosis dan manajemen stroke di IGD. Sumber literatur dari text book, artikel elektronik seperti ScienceDirect, PubMed, Cochrane Library dengan kriteria dipublikasi periode 2000-2016, pencarian menggunakan kata kunci”recognition, assessment, stroke, emergency”. Hasil penelusuran didapatkan 21 artikel tentang pengkajian/pengenalan gejala, diagnosis dan menajemen stroke, hanya 7 artikel yang memenuhi kriteria inklusi. Literatur review menunjukkan bahwa aktivasi protokol manajemen stroke segera dilakukan dengan pertama kali menentukan tipe atau diagnosis stroke pasien. Penentuan diagnosis penting untuk dilakukan sebagai dasar memberikan terapi. Penentuannya biasanya menggunakan CT-Scan untuk membedakan stroke akut atau gejala mirip stroke. Tidak semua rumah sakit tersedia CT-Scan sehingga sebagai alternatif dapat menggunakan ROSIER scale dengan sensitifitas 93% dan nilai prediksi positif 90% membedakan stroke akut dan bukan stroke. Terdapat 7 aitem penilaian yaitu kehilangan kesadaran atau sinkop, aktivitas kejang, kelemahan otot wajah/asimetris, kelemahan anggota gerak atas/asimetris, kelemahan anggota gerak bawah/asimetris, kesulitan bicara, gangguan lapang pandang. Total skor antara -2 sampai +5. Apabila pasien mendapat skor 1 atau lebih terdiagnosis stroke dan skor ≤ 0 maka bukan stroke kecuali skor total 0. ROSIER merupakan skala diagnosis simple, sensitif, spesifik dan cocok digunakan saat triage di IGD. Penggunaannya juga sangat cepat dan mudah sehingga semakin cepat identifikasi pasien stroke untuk mendapatkan tindakan yang dapat menurunkan angka kematian dan kecacatan.

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Development of a new stroke scale in an emergency setting

Cited by 16 publications

References 35 publications

Diagnostic accuracy of clinical tools for assessment of acute stroke: a systematic review

Diagnostic accuracy of clinical tools for assessment of acute stroke: a systematic review

Diagnostic accuracy of clinical tools for assessment of acute stroke: a systematic review

Peran Perawat dalam Assessment Pengenalan Dini untuk Meningkatkan Outcome Pasien Stroke di Instalasi Gawat Darurat

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