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Abstract
Originally Published 11 March 2021
Free Access

Abstract P137: Large Vessel Occlusion Prediction Scale Thresholds That Are Sensitive for DAWN Trial Participants

Abstract

Introduction: Large Vessel Occlusion (LVO) prediction scales are used to triage prehospital suspected stroke patients with a high probability of LVO stroke to endovascular therapy centers. The sensitivities of these scales in the 6 to 24 hour window are unknown. Higher scale score thresholds are typically less sensitive and more specific. Knowing the highest scale score thresholds that remain sensitive could inform threshold selection for clinical use. Sensitivities may also vary between left and right sided LVOs.
Methods: LVO prediction scale scores were retrospectively calculated using the NIHSS sub-item scores of patients enrolled in the DAWN Trial. All patients had last known well times between 6 to 24 hours, NIHSS scores ≥ 10, intracranial ICA or proximal MCA occlusions, and mismatches between their exam severities and infarct core volumes. Scale thresholds with sensitivities ≥ 85% were identified. Scores ≥ 5% more sensitive for left or right sided LVOs were identified. Specificities could not be calculated because all DAWN Trial patients had LVOs.
Results: 201 out of 206 patients had the required NIHSS sub-item scores. The highest score thresholds that maintained sensitivities ≥ 85% are bolded in the table.
Conclusions: CPSS = 3, C-STAT ≥ 2, FAST-ED ≥ 4, G-FAST ≥ 3, RACE ≥ 5, and SAVE ≥ 3 are likely the highest thresholds that can be selected for extended window LVO triage without missing more than 15% of DAWN Trial eligible LVO strokes. For CPSS and SAVE, these are higher than the thresholds suggested by prior studies. CPSS = 3 and RACE ≥ 5 were more sensitive for right sided LVOs. These findings represent the maximum anticipated sensitivities of LVO prediction scales since the NIHSS scores were documented in hospitals during a clinical trial rather than in the prehospital setting. Inclusion of lower NIHSS or more distal LVO patients would lower sensitivities further. Selecting even higher scale thresholds for LVO triage would lead to many missed LVO strokes.

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Published in print: March 2021
Published online: 11 March 2021

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Keywords

  1. Emergency medical services (EMS)
  2. Prehospital care
  3. Neuroendovascular (for stroke)
  4. Interventional neurovascular
  5. Emergency cardiovascular care

Authors

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Kevin J Keenan
Univ of California, Davis, Sacramento, CA
Wade S Smith
Univ of California, San Francisco, San Francisco, CA
Ashutosh P Jadhav
UPMC Presbyterian/Shadyside Hosp, Pittsburgh, PA
Diogo C Haussen
Emory Univ Sch of Medicine at Grady Memorial Hosp, Atlanta, GA
Ronald F Budzik
Riverside Methodist Hosp, Columbus, OH
Alain Bonafe
Hopital Gui de Chauliac, Montpellier, France
Parita Bhuva
Texas Stroke Institute at HCA North Texas, Plano, TX
Dileep R Yavagal
Jackson Memorial Hosp, Miami, FL
Marc Ribo
Hosp Vall d’Hebron, Barcelona, Spain
Christophe Cognard
Hopital Purpan Toulouse, Toulouse, France
Ricardo A Hanel
Baptist Jacksonville/Lyerly Neurosurgery, Jacksonville, FL
Ameer E Hassan
Valley Baptist Med Cntr, Harlingen, TX
Cathy A Sila
Univ Hosps Case Med Cntr, Cleveland, OH
Jeffrey L Saver
Univ of California Los Angeles, Los Angeles, CA
David S Liebeskind
Univ of California Los Angeles, Los Angeles, CA
Tudor G Jovin
Cooper Neurological Institute, Camden, NJ
Raul G Nogueira
Emory Univ Sch of Medicine at Grady Memorial Hosp, Atlanta, GA

Notes

Author Disclosures: For author disclosure information, please visit the ASA International Stroke Conference 2021 Online Program Planner and search for the abstract title.

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Abstract P137: Large Vessel Occlusion Prediction Scale Thresholds That Are Sensitive for DAWN Trial Participants
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