The Accuracy of Large Vessel Occlusion Recognition Scales in Telestroke Setting

Anadani, Mohammad; Almallouhi, Eyad; Wahlquist, Amy E.; Debenham, Ellen; Holmstedt, Christine A

doi:10.1089/tmj.2018.0232

Cited by 17 publications

(21 citation statements)

References 38 publications

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“…Jumaa et al found that RACE ≥ 5 had a sensitivity of 77% and specificity of 75% for LVO eligible for mechanical thrombectomy among a cohort of 1147 patients in the United States [ 30 ]. Additional scales that have undergone head-to-head comparisons with RACE with comparable performance include the FAST-ED and the CPSS tools [ 31 , 32 ]. The performance characteristics of FAST-ED and CPSS were assessed in 5 (26%) articles.…”

Section: Resultsmentioning

confidence: 99%

Prehospital triage tools across the world: a scoping review of the published literature

Bhaumik

Hannun

Dymond

et al. 2022

Scand J Trauma Resusc Emerg Med

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Background Accurate triage of the undifferentiated patient is a critical task in prehospital emergency care. However, there is a paucity of literature synthesizing currently available prehospital triage tools. This scoping review aims to identify published tools used for prehospital triage globally and describe their performance characteristics. Methods A comprehensive search was performed of primary literature in English-language journals from 2009 to 2019. Papers included focused on emergency medical services (EMS) triage of single patients. Two blinded reviewers and a third adjudicator performed independent title and abstract screening and subsequent full-text reviews. Results Of 1521 unique articles, 55 (3.6%) were included in the final synthesis. The majority of prehospital triage tools focused on stroke (n = 19; 35%), trauma (19; 35%), and general undifferentiated patients (15; 27%). All studies were performed in high income countries, with the majority in North America (23, 42%) and Europe (22, 40%). 4 (7%) articles focused on the pediatric population. General triage tools aggregate prehospital vital signs, mental status assessments, history, exam, and anticipated resource need, to categorize patients by level of acuity. Studies assessed the tools’ ability to accurately predict emergency department triage assignment, hospitalization and short-term mortality. Stroke triage tools promote rapid identification of patients with acute large vessel occlusion ischemic stroke to trigger timely transport to diagnostically- and therapeutically-capable hospitals. Studies evaluated tools’ diagnostic performance, impact on tissue plasminogen activator administration rates, and correlation with in-hospital stroke scales. Trauma triage tools identify patients that require immediate transport to trauma centers with emergency surgery capability. Studies evaluated tools’ prediction of trauma center need, under-triage and over-triage rates for major trauma, and survival to discharge. Conclusions The published literature on prehospital triage tools predominantly derive from high-income health systems and mostly focus on adult stroke and trauma populations. Most studies sought to further simplify existing triage tools without sacrificing triage accuracy, or assessed the predictive capability of the triage tool. There was no clear ‘gold-standard’ singular prehospital triage tool for acute undifferentiated patients. Trial registration Not applicable.

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Section: Resultsmentioning

confidence: 99%

Prehospital triage tools across the world: a scoping review of the published literature

Bhaumik

Hannun

Dymond

et al. 2022

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

show abstract

“…The performance characteristics of FAST-ED and CPSS were assessed in 5 (26%) of articles. Overall, both have comparable sensitivity (56-83%) and speci city (60-89%) for LVO prediction [30,31].…”

Section: Stroke Triagementioning

confidence: 93%

“…Jumaa et al found that RACE ≥ 5 had a sensitivity of 77% and speci city of 75% for LVO eligible for mechanical thrombectomy among a cohort of 1147 patients in the United States [29]. Additional scales that have undergone head-to-head comparisons with RACE with comparable performance include the FAST-ED and the CPSS tools [30,31]. The performance characteristics of FAST-ED and CPSS were assessed in 5 (26%) of articles.…”

Section: Stroke Triagementioning

confidence: 99%

Prehospital Triage Tools across the World: A Scoping Review of the Published Literature

Bhaumik

Hannun

Dymond

et al. 2021

Preprint

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BackgroundAccurate triage of the undifferentiated patient is a critical task in prehospital emergency care. This scoping review aims to identify published tools used for prehospital triage across the world and describe their performance characteristics.MethodsA comprehensive search was performed of primary literature in English-language journals from 2009 to 2019. Papers included focused on emergency medical services (EMS) triage of single patients. Two blinded reviewers and a third adjudicator performed independent title and abstract screening and subsequent full-text reviews. ResultsOf 1521 unique articles, 55 (3.6%) were included in the final synthesis. The majority of prehospital triage tools focused on stroke (n=19; 35%), trauma (19; 35%), and general undifferentiated patients (15; 27%). All studies, and resulting articles, were performed in high income countries, with the majority in North America (23, 42%) and Europe (22, 40%). 4 (7%) articles focused on the pediatric population. The general triage tools aggregated prehospital vital signs, mental status assessments, and sometimes, features of the history, exam, and anticipated resource need, to categorize patients into numerical or color categories to represent level of acuity. The studies assessed the tools’ ability to accurately predict emergency department triage assignment, hospitalization and short-term mortality. The stroke triage tools were designed to promote rapid identification of patients with acute large vessel occlusion ischemic stroke to trigger timely transport to diagnostically- and therapeutically-capable hospitals. Stroke triage literature evaluates tools’ diagnostic performance, impact on tissue plasminogen activator administration rates, and correlation with in-hospital stroke scales. Trauma triage tools sought to identify patients that require immediate transport to trauma centers with emergency surgery capability. The studies on trauma triage evaluate prediction of trauma center need, under-triage and over-triage rates for major trauma, and survival to discharge.ConclusionsThe published literature on prehospital triage tools predominantly derive from high-income health systems and mostly focus on adult stroke and trauma populations. Most studies sought to further simplify existing triage tools, without sacrificing triage accuracy, or assessed the predictive capability of the triage tool. There was no clear ‘gold-standard’ singular prehospital triage tool for acute undifferentiated patients. Trial RegistrationNot applicable.

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“…Detection techniques with sensitivity and specificity values of <50% could suggest they are worse than chance. As a good comparator throughout this review, the commonly used National Institutes of Health Stroke Scale (NIHSS), at a cut-off of ≥11, has been reported to have a sensitivity of 86% and a specificity of 60% for LVO (7).…”

Section: Introductionmentioning

confidence: 99%

Emerging Detection Techniques for Large Vessel Occlusion Stroke: A Scoping Review

et al. 2022

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Background: Large vessel occlusion (LVO) is the obstruction of large, proximal cerebral arteries and can account for up to 46% of acute ischaemic strokes (AIS) when both the A2 and P2 segments are included (from the anterior and posterior cerebral arteries). It is of paramount importance that LVO is promptly recognised to provide timely and effective acute stroke management. This review aims to scope recent literature to identify new emerging detection techniques for LVO. As a good comparator throughout this review, the commonly used National Institutes of Health Stroke Scale (NIHSS), at a cut-off of ≥11, has been reported to have a sensitivity of 86% and a specificity of 60% for LVO.Methods: Four electronic databases (Medline via OVID, CINAHL, Scopus, and Web of Science), and grey literature using OpenGrey, were systematically searched for published literature investigating developments in detection methods for LVO, reported from 2015 to 2021. The protocol for the search was published with the Open Science Framework (10.17605/OSF.IO/A98KN). Two independent researchers screened the titles, abstracts, and full texts of the articles, assessing their eligibility for inclusion.Results: The search identified 5,082 articles, in which 2,265 articles were screened to assess their eligibility. Sixty-two studies remained following full-text screening. LVO detection techniques were categorised into 5 groups: stroke scales (n = 30), imaging and physiological methods (n = 15), algorithmic and machine learning approaches (n = 9), physical symptoms (n = 5), and biomarkers (n = 3).Conclusions: This scoping review has explored literature on novel and advancements in pre-existing detection methods for LVO. The results of this review highlight LVO detection techniques, such as stroke scales and biomarkers, with good sensitivity and specificity performance, whilst also showing advancements to support existing LVO confirmatory methods, such as neuroimaging.

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The Accuracy of Large Vessel Occlusion Recognition Scales in Telestroke Setting

Cited by 17 publications

References 38 publications

Prehospital triage tools across the world: a scoping review of the published literature

Prehospital triage tools across the world: a scoping review of the published literature

Prehospital Triage Tools across the World: A Scoping Review of the Published Literature

Emerging Detection Techniques for Large Vessel Occlusion Stroke: A Scoping Review

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