■大血管闭塞(LVO)中风与更高的死亡率和更大的长期残疾风险有关。本研究旨在通过系统评价和荟萃分析评估快速动脉闭塞评估(RACE)工具在检测LVO方面的诊断性能。
■对包括PubMed在内的在线数据库进行了全面搜索,Embase,Scopus,和WebofScience,到6月25日,2023年。此外,在Google和GoogleScholar上进行了一项手动搜索,以确定评估RACE量表在有卒中症状的患者中检测LVO的诊断准确性的研究.
■分析了从43项研究中提取的数据。最佳截止点确定为3和4,截止点≥3的敏感性为0.86(95%置信区间(CI):0.78,0.91),特异性为0.57(95%CI:0.49,0.67),截止点≥4的敏感性为0.78(95%CI:0.70,0.84),特异性为0.68(95%CI:0.59,0.75)。亚组荟萃回归分析显示在敏感性和特异性方面存在显著差异。RACE量表在疑似卒中病例的LVO检测中的敏感性明显较高,在院前设置,前瞻性设计研究,以及在考虑LVO定义的前后闭塞时。RACE量表的特异性在评估确诊卒中病例时显著更高,在医院设置,仅考虑前路闭塞的LVO定义和回顾性设计研究。值得注意的是,与其他急诊人员相比,神经科医师和医师使用RACE时表现出更高的敏感性和特异性。尽管有这些变化,我们的研究发现,不同条件下的诊断准确率具有可比性.
■高水平的证据表明,RACE量表对检测LVOs缺乏有希望的诊断价值。对于旨在帮助诊断中风的筛查工具,灵敏度范围为0.69至0.86是不够的。考虑到与这种情况相关的大量发病率和死亡率。
UNASSIGNED: Large vessel occlusion (LVO) strokes are linked to higher mortality rates and a greater risk of long-term disability. This study aimed to evaluate the diagnostic performance of the Rapid Arterial Occlusion Evaluation (RACE) tool in detecting LVO through a systematic
review and meta-analysis.
UNASSIGNED: A comprehensive search was conducted across online databases including PubMed, Embase, Scopus, and Web of Science, up to June 25th, 2023. Additionally, a manual search on Google and Google Scholar was performed to identify studies that assessed the diagnostic accuracy of the RACE scale in detecting LVO among patients with stroke symptoms.
UNASSIGNED: Data extracted from 43 studies were analyzed. The optimal cut-off points were determined to be 3 and 4, with a sensitivity of 0.86 (95% confidence interval (CI): 0.78, 0.91) and specificity of 0.57 (95% CI: 0.49, 0.67) for cut-off ≥3, and a sensitivity of 0.78 (95% CI: 0.70, 0.84) and specificity of 0.68 (95% CI: 0.59, 0.75) for cut-off ≥4. Subgroup meta-regression analysis revealed significant variations in sensitivity and specificity. RACE scale\'s sensitivity was significantly higher in LVO detection in suspected stroke cases, in pre-hospital settings, prospective design studies, and when considering both anterior and posterior occlusions for LVO definition. RACE scale\'s specificity was significantly higher when evaluating confirmed stroke cases, in-hospital settings, and considering only anterior occlusions for LVO definition and retrospective design studies. Notably, RACE exhibited higher sensitivity and specificity when utilized by neurologists and physicians compared to other emergency staff. Despite these variations, our study found comparable diagnostic accuracy across different conditions.
UNASSIGNED: A high level of evidence indicates that the RACE scale lacks promising diagnostic value for detection of LVOs. A sensitivity range of 0.69 to 0.86 is insufficient for a screening tool intended to aid in the diagnosis of strokes, considering the substantial morbidity and mortality associated with this condition.