FAST-ED 评估急诊科急性缺血性脑卒中大血管闭塞的准确性。

IF 1.5 Q3 EMERGENCY MEDICINE Open Access Emergency Medicine Pub Date : 2024-08-22 eCollection Date: 2024-01-01 DOI:10.2147/OAEM.S461177
Chatchanan Pornpanit, Punnaporn Loymai, Nattaphol Uransilp, Winchana Srivilaithon
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引用次数: 0

摘要

背景:急性大血管闭塞性卒中(LVOS)需要快速、精确的评估才能进行有效治疗。现场评估卒中急救分流(FAST-ED)方案显示了快速评估 LVOS 的前景,但缺乏广泛的验证。本研究旨在评估 FAST-ED 预测 LVOS 的准确性,并将其预测能力与美国国立卫生研究院卒中量表(NIHSS)进行比较:这项前瞻性横断面研究在 Thammasat 大学医院进行。参与者包括年龄在 18 岁或 18 岁以上、在发病 24 小时内出现急性卒中综合征症状的患者。研究重点是比较急诊科医生的 FAST-ED 评估和神经科医生的 NIHSS 评估,然后进行血管成像,包括脑多相 CT 血管造影、MRA 核磁共振成像、经颅多普勒超声和颈动脉多普勒超声。统计分析包括使用 AuROC 评估 FAST-ED 的有效性,并将 FAST-ED 与 NIHSS 进行比较:分析共纳入 130 名患者,其中 47 人确诊为 LVOS。除 LVOS 组心房颤动发生率较高和收缩压较低外,LVOS 组和非 LVOS 组的大多数基线特征无明显差异。FAST-ED 量表对 LVOS 的预测能力一般,AuROC 为 0.79(95% 置信区间 (CI);0.70, 0.87)。FAST-ED切点≥4可提高特异性和似然比。将FAST-ED≥4与NIHSS≥6进行比较,发现两者的AuROC相似(分别为0.74,95% CI;0.65,0.82和0.72,95% CI;0.64,0.80),无显著统计学差异(P=0.661):结论:FAST-ED 量表,尤其是截断点≥4 的量表,在预测急诊室 24 小时内疑似急性卒中患者的 LVOS 方面总体准确性尚可。这一预测能力与截断点≥6 的 NIHSS 非常接近。
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Accuracy of FAST-ED for Assessment Large Vessel Occlusion of Acute Ischemic Stroke in Emergency Department.

Background: Acute large vessel occlusion stroke (LVOS) requires swift and precise assessment for effective treatment. The Field Assessment Stroke Triage for Emergency Destination (FAST-ED) protocol shows promise for rapid LVOS evaluation but lacks extensive validation. This study aims to assess the accuracy of FAST-ED in predicting LVOS and compare its predictive capability with the National Institute of Health Stroke Scale (NIHSS).

Methods: This prospective cross-sectional study was conducted at Thammasat University Hospital. Participants included those aged 18 years or older who presented with symptoms of acute stroke syndrome within 24 hours of onset. The study focused on comparing FAST-ED assessments by emergency department physicians with NIHSS evaluations by neurologists, followed by vascular imaging, which included brain multiphase CT angiography, MRI with MRA, and transcranial Doppler ultrasound combined with carotid Doppler ultrasound. Statistical analyses included the use of AuROC to assess the effectiveness of FAST-ED and to compare FAST-ED with NIHSS.

Results: 130 patients were included in the analysis, with 47 diagnosed with LVOS. No significant differences were found in most baseline characteristics between LVOS and non-LVOS groups, except for a higher prevalence of atrial fibrillation and lower systolic blood pressure in the LVOS group. The FAST-ED scale demonstrated a fair ability to predict LVOS with an AuROC of 0.79 (95% confidence interval (CI); 0.70, 0.87). A FAST-ED cut point of ≥4 showed improved specificity and likelihood ratio. Comparing FAST-ED≥4 with NIHSS≥6 revealed similar AuROC (0.74, 95% CI; 0.65, 0.82 and 0.72, 95% CI; 0.64, 0.80, respectively), with no significant statistical difference (p=0.661).

Conclusion: FAST-ED scale, especially with a cut-off point of ≥4, exhibits fair overall accuracy in predicting LVOS in patients who presented with suspected acute stroke within 24 hours at the ED. This predictive capability is closely comparable to that of the NIHSS at a cut-off point of ≥6.

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来源期刊
Open Access Emergency Medicine
Open Access Emergency Medicine EMERGENCY MEDICINE-
CiteScore
2.60
自引率
6.70%
发文量
85
审稿时长
16 weeks
期刊最新文献
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