Prehospital Validation of the Scale to Identify Large Vessel Occlusion in Suspected Stroke Patients.
Maria Prehospital Stroke Scale+4 scale best predicted large vessel occlusion in prehospital stroke patients
Prehospital Validation of the Scale to Identify Large Vessel Occlusion in Suspected Stroke Patients.
Timely identification and transfer of patients with large vessel occlusion (large vessel occlusion) to thrombectomy-capable stroke centers (TSCs) for endovascular thrombectomy (endovascular thrombectomy) remains a major challenge in prehospital stroke care.
This study evaluated the clinimetric performance of the Cincinnati Prehospital Stroke Scale (Cincinnati Prehospital Stroke Scale), the Maria Prehospital Stroke Scale (Maria Prehospital Stroke Scale) and novel large vessel occlusion (large vessel occlusion) screening scales created by integrating four large vessel occlusion-related items into these established prehospital assessments.
Using prehospital electronic records linked with hospital data across Kawasaki City from April 2023 to March 2024, we retrospectively analyzed whether the addition of aphasia, unilateral spatial neglect (unilateral spatial neglect), conjugate eye deviation, and atrial fibrillation (via ambulance ECG) improved prehospital large vessel occlusion detection.
higher scores predict large vessel occlusion well, 1.0 would be perfect prediction
Among 1,653 transported patients, 207 (12.5%) had large vessel occlusion.
The addition of the four large vessel occlusion-related items significantly improved large vessel occlusion prediction for both Maria Prehospital Stroke Scale and Cincinnati Prehospital Stroke Scale (p < 0.001 for each).
Higher Maria Prehospital Stroke Scale+4 scale scores were strongly and progressively associated with the likelihood of receiving endovascular therapy (endovascular thrombectomy) after hospital arrival.
Adjusted odds ratios increased from 2.97 to 100.59 for scores 2-9 compared with a score of 1.
Incorporating large vessel occlusion-related items into prehospital stroke assessment substantially improved diagnostic precision for large vessel occlusion, with Maria Prehospital Stroke Scale+4 scale outperforming all other tools.
The strong association between Maria Prehospital Stroke Scale+4 scale scores and subsequent endovascular thrombectomy implementation suggests that Maria Prehospital Stroke Scale+4 scale may serve as a practical, clinically meaningful instrument for emergency medical technicians in prehospital triage of suspected acute stroke and identification of endovascular thrombectomy candidates.