Prospective evaluation of modified Cincinnati Prehospital Stroke Severity Scale for identifying large vessel occlusion

Objective

To develop a novel, straightforward diagnostic scale for predicting large vessel occlusion (LVO) and anterior circulation LVO (ALVO) in the emergency setting, evaluating its validity against existing scales.

Methods

We prospectively enrolled patients with suspected stroke presenting consecutively at the National Comprehensive Stroke Centre’s emergency department between February 20, 2022, and November 11, 2022. Emergency physicians assessed each patient using the modified Cincinnati Prehospital Stroke Severity Scale (mCPSSS) and the National Institutes of Health Stroke Scale (NIHSS). The study analyzed the mCPSSS and other prevalent stroke scales to evaluate their efficacy in detecting LVO and ALVO, employing receiver operating characteristic curve (ROC) analysis and area under the curve (AUC) statistics to assess the scales’ sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy.

Results

A total of 383 patients with suspected stroke were included in this study. The performance in identifying LVO in the emergency setting was greatest for mCPSSS ≥ 2 with a sensitivity of 0.802 and specificity of 0.770, PPV of 0.644, NPV of 0.882, and accuracy of 0.781. mCPSSS ≥ 2 was 0.766 sensitive, 0.733 specific, PPV of 0.564, NPV of 0.886, and accuracy of 0.749 in predicting ALVO. The mCPSSS identified LVO and ALVO with an optimal cut-off value of 2, exhibiting AUC superior to those of other widely used stroke scales, with AUC values of 0.824 for LVO and 0.790 for ALVO.

Conclusion

The mCPSSS could serve as an effective and straightforward scale for identifying LVOs in emergency settings.

Clinical Trial Registration information: https://www.chictr.org.cn/ (ChiCTR2200056776).