Validation of the National Institutes of Health Stroke Scale-8 to Detect Large Vessel Occlusion in Ischemic Stroke

Demeestere, Jelle; García-Esperón, Carlos; Lin, Longting; Bivard, Andrew; Ang, Timothy; Smoll, Nicolas R.; Garnett, A Randolph; Loudfoot, Allan; Miteff, Ferdi; Spratt, Neil J; Levi, Christopher

doi:10.1016/j.jstrokecerebrovasdis.2017.03.020

Cited by 32 publications

(42 citation statements)

References 21 publications

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“…Previous scoring systems consisting of clinical manifestations may be affected by the examiner's experience and special training is needed to reduce inter-observer variability [27]. Some validation studies on early recognition scoring systems reported high variability in inter-observer reliability ranging from 69% to 90% [14,28]. To compensate for these variations, ROSIER [8] and LAPSS [15] included laboratory finding such as blood glucose levels.…”

Section: Plos Onementioning

confidence: 99%

Stepwise stroke recognition through clinical information, vital signs, and initial labs (CIVIL): Electronic health record-based observational cohort study

et al. 2020

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Background Stroke recognition systems have been developed to reduce time delays, however, a comprehensive triaging score identifying stroke subtypes is needed to guide appropriate management. We aimed to develop a prehospital scoring system for rapid stroke recognition and identify stroke subtype simultaneously. Methods and findings In prospective database of regional emergency and stroke center, Clinical Information, Vital signs, and Initial Labs (CIVIL) of 1,599 patients suspected of acute stroke was analyzed from an automatically-stored electronic health record. Final confirmation was performed with neuroimaging. Using multiple regression analyses, we determined independent predictors of tier 1 (true-stroke or not), tier 2 (hemorrhagic stroke or not), and tier 3 (emergent large vessel occlusion [ELVO] or not). The diagnostic performance of the stepwise CIVIL scoring system was investigated using internal validation. A new scoring system characterized by a stepwise clinical assessment has been developed in three tiers. Tier 1: Seven CIVIL-AS 3 A 2 P items (total score from-7 to +6) were deduced for true stroke as Age (� 60 years); Stroke risks without Seizure or psychiatric disease, extreme Sugar; "any Asymmetry", "not Ambulating"; abnormal blood Pressure at a cutoff point � 1 with diagnostic sensitivity of 82.1%, specificity of 56.4%. Tier 2: Four items for hemorrhagic stroke were identified as the CIVIL-MAPS indicating Mental change, Age below 60 years, high blood Pressure, no Stroke risks with cut-point � 2 (sensitivity 47.5%, specificity 85.4%). Tier 3: For ELVO diagnosis: we applied with CIVIL-GFAST items (Gaze, Face, Arm, Speech) with cut-point � 3 (sensitivity 66.5%, specificity 79.8%). The main limitation of this study is its retrospective nature and require a prospective validation of the CIVIL scoring system.

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Section: Plos Onementioning

confidence: 99%

Stepwise stroke recognition through clinical information, vital signs, and initial labs (CIVIL): Electronic health record-based observational cohort study

et al. 2020

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“…The diagnosis of anterior circulation LVO was independently verified by two cerebrovascular disease specialists (>8 years experiences in interpretation of acute stroke neuroimaging) based on available admission notes, discharge notes, and CT scans on admission and 24-72 h after stroke onset. Those with severe stroke (NIHSS > 8) and corresponding large infarct in the ICA or MCA territories on the follow-up CT were considered LVO when no CT angiogram was available at presentation (Demeestere et al, 2017). Any discrepancies were resolved by consensus.…”

Section: Study Population and Data Acquisitionmentioning

confidence: 99%

Automated Hierarchy Evaluation System of Large Vessel Occlusion in Acute Ischemia Stroke

You

Tsang

et al. 2020

Front. Neuroinform.

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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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Validation of the National Institutes of Health Stroke Scale-8 to Detect Large Vessel Occlusion in Ischemic Stroke

Cited by 32 publications

References 21 publications

Stepwise stroke recognition through clinical information, vital signs, and initial labs (CIVIL): Electronic health record-based observational cohort study

Stepwise stroke recognition through clinical information, vital signs, and initial labs (CIVIL): Electronic health record-based observational cohort study

Automated Hierarchy Evaluation System of Large Vessel Occlusion in Acute Ischemia Stroke

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

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