Abstract：
UNASSIGNED: Several prehospital scales have been designed to aid paramedics in identifying stroke patients in the ambulance setting. However, external validation and comparison of these scales are largely lacking.
UNASSIGNED: To compare all published prehospital stroke detection scales in a large cohort of unselected stroke code patients.
UNASSIGNED: We conducted a systematic literature search to identify all stroke detection scales. Scales were reconstructed with prehospital acquired data from two observational cohort studies: the Leiden Prehospital Stroke Study (LPSS) and PREhospital triage of patients with suspected STrOke (PRESTO) study. These included stroke code patients from four ambulance regions in the Netherlands, including 15 hospitals and serving 4 million people. For each scale, we calculated the accuracy, sensitivity, and specificity for a diagnosis of stroke (ischemic, hemorrhagic, or transient ischemic attack (TIA)). Moreover, we assessed the proportion of stroke patients who received reperfusion treatment with intravenous thrombolysis or endovascular thrombectomy that would have been missed by each scale.
UNASSIGNED: We identified 14 scales, of which 7 (CPSS, FAST, LAPSS, MASS, MedPACS, OPSS, and sNIHSS-EMS) could be reconstructed. Of 3317 included stroke code patients, 2240 (67.5%) had a stroke (1528 ischemic, 242 hemorrhagic, 470 TIA) and 1077 (32.5%) a stroke mimic. Of ischemic stroke patients, 715 (46.8%) received reperfusion treatment. Accuracies ranged from 0.60 (LAPSS) to 0.66 (MedPACS, OPSS, and sNIHSS-EMS), sensitivities from 66% (LAPSS) to 84% (MedPACS and sNIHSS-EMS), and specificities from 28% (sNIHSS-EMS) to 49% (LAPSS). MedPACS, OPSS, and sNIHSS-EMS missed the fewest reperfusion-treated patients (10.3-11.2%), whereas LAPSS missed the most (25.5%).
UNASSIGNED: Prehospital stroke detection scales generally exhibited high sensitivity but low specificity. While LAPSS performed the poorest, MedPACS, sNIHSS-EMS, and OPSS demonstrated the highest accuracy and missed the fewest reperfusion-treated stroke patients. Use of the most accurate scale could reduce unnecessary stroke code activations for patients with a stroke mimic by almost a third, but at the cost of missing 16% of strokes and 10% of patients who received reperfusion treatment.
UNASSIGNED: To compare all published prehospital stroke detection scales in a large cohort of unselected stroke code patients.
UNASSIGNED: We conducted a systematic literature search to identify all stroke detection scales. Scales were reconstructed with prehospital acquired data from two observational cohort studies: the Leiden Prehospital Stroke Study (LPSS) and PREhospital triage of patients with suspected STrOke (PRESTO) study. These included stroke code patients from four ambulance regions in the Netherlands, including 15 hospitals and serving 4 million people. For each scale, we calculated the accuracy, sensitivity, and specificity for a diagnosis of stroke (ischemic, hemorrhagic, or transient ischemic attack (TIA)). Moreover, we assessed the proportion of stroke patients who received reperfusion treatment with intravenous thrombolysis or endovascular thrombectomy that would have been missed by each scale.
UNASSIGNED: We identified 14 scales, of which 7 (CPSS, FAST, LAPSS, MASS, MedPACS, OPSS, and sNIHSS-EMS) could be reconstructed. Of 3317 included stroke code patients, 2240 (67.5%) had a stroke (1528 ischemic, 242 hemorrhagic, 470 TIA) and 1077 (32.5%) a stroke mimic. Of ischemic stroke patients, 715 (46.8%) received reperfusion treatment. Accuracies ranged from 0.60 (LAPSS) to 0.66 (MedPACS, OPSS, and sNIHSS-EMS), sensitivities from 66% (LAPSS) to 84% (MedPACS and sNIHSS-EMS), and specificities from 28% (sNIHSS-EMS) to 49% (LAPSS). MedPACS, OPSS, and sNIHSS-EMS missed the fewest reperfusion-treated patients (10.3-11.2%), whereas LAPSS missed the most (25.5%).
UNASSIGNED: Prehospital stroke detection scales generally exhibited high sensitivity but low specificity. While LAPSS performed the poorest, MedPACS, sNIHSS-EMS, and OPSS demonstrated the highest accuracy and missed the fewest reperfusion-treated stroke patients. Use of the most accurate scale could reduce unnecessary stroke code activations for patients with a stroke mimic by almost a third, but at the cost of missing 16% of strokes and 10% of patients who received reperfusion treatment.
摘要：
背景：已经设计了几种院前量表来帮助护理人员识别救护车环境中的中风患者。然而,这些量表的外部验证和比较在很大程度上缺乏。
目的：比较所有已发表的院前卒中检测量表在大量未经选择的卒中编码患者中的应用。
方法：我们进行了系统的文献检索，以确定所有中风检测量表。使用来自两项观察性队列研究的院前获得的数据重建量表：莱顿院前卒中研究（LPSS）和疑似STROke患者的院前分诊（PRESTO）研究。其中包括来自荷兰四个救护车地区的中风代码患者，包括15家医院，为400万人提供服务。对于每个刻度，我们计算了准确度，诊断中风的敏感性和特异性(缺血性，出血性或TIA）。此外，我们评估了接受静脉溶栓或血管内血栓切除术再灌注治疗的卒中患者的比例,而这些患者在每个量表中都会被遗漏.
结果：我们确定了14个量表，其中七个(CPSS，FAST,LAPSS,质量,MedPACS,OPSS,和sNIHSS-EMS)可以重建。在3317名中风患者中，2240（67.5％）中风（1528缺血性，242出血性，470TIA）和1077（32.5％）中风模仿。缺血性中风患者，715例(46.8%)接受再灌注治疗。精度范围从0.60(LAPSS)到0.66(MedPACS，OPSS和sNIHSS-EMS)，敏感性从66%(LAPSS)到84%(MedPACS和sNIHSS-EMS)，特异性从28%(sNIHSS-EMS)到49%(LAPSS)。MedPACS,OPSS和sNIHSS-EMS错过了最少的再灌注治疗患者（10.3-11.2％），而LAPSS错过的最多(25.5%)。
结论：院前卒中检测量表通常表现出较高的敏感性，但特异性较低。虽然LAPSS表现最差，MedPACS,sNIHSS-EMS和OPSS显示出最高的准确性，并且错过了最少的再灌注治疗的中风患者。使用最准确的量表可以将模仿中风的患者不必要的中风代码激活减少近三分之一，但代价是16％的中风和10％的患者接受再灌注治疗。
目的：比较所有已发表的院前卒中检测量表在大量未经选择的卒中编码患者中的应用。
方法：我们进行了系统的文献检索，以确定所有中风检测量表。使用来自两项观察性队列研究的院前获得的数据重建量表：莱顿院前卒中研究（LPSS）和疑似STROke患者的院前分诊（PRESTO）研究。其中包括来自荷兰四个救护车地区的中风代码患者，包括15家医院，为400万人提供服务。对于每个刻度，我们计算了准确度，诊断中风的敏感性和特异性(缺血性，出血性或TIA）。此外，我们评估了接受静脉溶栓或血管内血栓切除术再灌注治疗的卒中患者的比例,而这些患者在每个量表中都会被遗漏.
结果：我们确定了14个量表，其中七个(CPSS，FAST,LAPSS,质量,MedPACS,OPSS,和sNIHSS-EMS)可以重建。在3317名中风患者中，2240（67.5％）中风（1528缺血性，242出血性，470TIA）和1077（32.5％）中风模仿。缺血性中风患者，715例(46.8%)接受再灌注治疗。精度范围从0.60(LAPSS)到0.66(MedPACS，OPSS和sNIHSS-EMS)，敏感性从66%(LAPSS)到84%(MedPACS和sNIHSS-EMS)，特异性从28%(sNIHSS-EMS)到49%(LAPSS)。MedPACS,OPSS和sNIHSS-EMS错过了最少的再灌注治疗患者（10.3-11.2％），而LAPSS错过的最多(25.5%)。
结论：院前卒中检测量表通常表现出较高的敏感性，但特异性较低。虽然LAPSS表现最差，MedPACS,sNIHSS-EMS和OPSS显示出最高的准确性，并且错过了最少的再灌注治疗的中风患者。使用最准确的量表可以将模仿中风的患者不必要的中风代码激活减少近三分之一，但代价是16％的中风和10％的患者接受再灌注治疗。
