Improved performance of new prenotification criteria for acute stroke patients
Journal
Journal of the Formosan Medical Association
Journal Volume
115
Journal Issue
4
Pages
257-262
Date Issued
2016
Author(s)
Chang A.M.
Wang A.-Y.
Huang K.-Y.
Abstract
Background/purpose: We aim to evaluate the accuracy of the new prehospital notification criteria for patients with potential acute stroke in the prehospital setting. Methods: We conducted a retrospective observational study from March 2011 to February 2013 of potential acute stroke patients prenotified using the new criteria which were: (1) positive Cincinnati Prehospital Stroke Scale (CPSS); (2) symptom onset within 3 hours; and (3) blood glucose level > 60 mg/dL. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the new criteria were calculated and outcomes of acute stroke patients were reported. Data of all patients with stroke or transient ischemic attack (TIA) transported to the destination hospital were also obtained to evaluate the compliance of emergency medical technicians. Results: There were 2888 patients suspected of stroke by emergency medical technicians and 221 patients prenotified due to meeting the criteria. The PPV, NPV, sensitivity, and specificity of the new criteria were 76.9%, 96.6%, 64.9%, and 98.1%, respectively. Onset time > 3 hours (24/51, 47.1%) and seizure (27.5%) were the two most common conditions leading to false prenotification. Of all prenotified patients, 23.1% (51/221) received thrombolytic therapy. Hemorrhagic stroke or ischemic stroke with hemorrhagic transformation (53.8%) and minor symptoms or rapid recovery (26.9%) were the most common reasons excluding correctly prenotified patients from thrombolytic therapy. Conclusion: The accuracy of the new prehospital stroke criteria has higher PPV and specificity compared to previous CPSS validation studies. ? 2015 Formosan Medical Association.
SDGs
Other Subjects
fibrinolytic agent; glucose blood level; Article; brain hemorrhage; brain ischemia; cerebrovascular accident; Cincinnati Prehospital Stroke Scale; diagnostic accuracy; emergency care; fibrinolytic therapy; glucose blood level; human; major clinical study; predictive value; rescue personnel; seizure; sensitivity and specificity; transient ischemic attack; adult; aged; analysis; emergency health service; female; fibrinolytic therapy; Ischemic Attack, Transient; male; middle aged; retrospective study; severity of illness index; Stroke; Taiwan; tertiary care center; very elderly; Adult; Aged; Aged, 80 and over; Blood Glucose; Emergency Medical Services; Emergency Medical Technicians; Female; Humans; Ischemic Attack, Transient; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity; Severity of Illness Index; Stroke; Taiwan; Tertiary Care Centers; Thrombolytic Therapy
Type
journal article