Zwart, W. (Wouter) (2016) Prehospitale identificatie van grote cerebrale arterie occlusies bij het acute herseninfarct gebruikmakend van NIHSS. thesis, Medicine.
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Abstract
Background and purpose―In acute ischemic stroke it is important to distinguish between patients with and without a large artery occlusion (LAO) and detect LAO patients as early as possible because of choosing best revascularization therapy. We aimed to validate a 4-item National Institutes of Health Stroke Scale (NIHSS) for prehospital detecting patients with acute LAO stroke and we aimed to compose a 4-item NIHSS applicable for detecting LAO in anterior and posterior circulation strokes (apc-NIHSS). Methods―We included acute stroke patients who had a CT angiography and a NIHSS on admission and presented <6 hours. The apc-NIHSS was composed out of the four most predictive items of the NIHSS, obtained by a stepwise backward logistic regression. The apc-NIHSS scores level of consciousness (item 1A), best gaze, facial palsy and best language. We determined sensitivity, specificity, negative and positive predictive values, accuracy, the area under curve (AUC) and optimal cutoff of each clinical scale. Results―Of 184 eligible patients, 108 (58.7%) had a occlusion of the common or internal carotid artery, the A1 segment of the anterior cerebral artery, M1 or M2 segment of the middle cerebral artery, vertebral arteries or basilar artery. Highest accuracy was observed for apc-NIHSS, 75% (95%-CI 68-81). Optimal cutoff score was ≥3 and AUC was 0.81 (0.75-0.87). NIHSS and 4-sNIHSS were equally predictive of LAO, accuracy=72% (65-78) versus 71% (65-78) and AUC=0.77 (0.70-0.84) versus 0.75 (0.68-0.82). Cutoff scores were ≥9 (NIHSS) and ≥5 (4-sNIHSS). Conclusions―The NIHSS and the 4-sNIHSS can be of good use for detecting LAO in a prehospital setting. Applying them would lead to sending over 70% of acute stroke patients to the appropriate hospital. The apc-NIHSS can be used in both anterior and posterior circulation stroke and is potentially a better scale for detecting LAO than the NIHSS and the 4-sNIHSS.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Uyttenboogaart, Maarten and Luijckx, Gert Jan and Universitair Medisch Centrum Groningen and Neurologie |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:52 |
| Last Modified: | 25 Jun 2020 10:52 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1337 |
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