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Observational Study
. 2021 Apr;268(4):1358-1365.
doi: 10.1007/s00415-020-10286-8. Epub 2020 Nov 3.

Usefulness of a single-parameter tool for the prediction of large vessel occlusion in acute stroke

Franck Leibinger #  1 , Thibaut Allou  2 , Laurène Van Damme  2 , Chawki Jebali  3 , Caroline Arquizan  4 , Geoffroy Farouil  5 , Alexandre Laverdure  3 , Nicolas Gaillard  2   4 , Majo Ibanez  2 , Philippe Smadja  5 , Anais Dutray  2 , Maxime Tardieu  5 , Ludovic Nguyen Them  2 , Ali Ousji  3 , Snejana Jurici  2 , Gregory Gascou  6 , Zoubir Mourad Bensalah  5 , Nadège Olivier  2 , Frederique Damon  2   3 , Wael Chaabane  3 , Bénédicte Fadat  2 , Marlène Lachcar  3 , Julie Mas  2 , Isabelle Mourand  4 , Adelaïde Ferraro  2 , Didier Heve  7 , Adrian Dumitrana  2 , Jean-Christophe Blenet  3 , Sabine Aptel  5 , Vincent Costalat  6 , Alain Bonafe  5   6 , Laurent Ortega  3 , Denis Sablot #  8   9
Affiliations
Observational Study

Usefulness of a single-parameter tool for the prediction of large vessel occlusion in acute stroke

Franck Leibinger et al. J Neurol. 2021 Apr.

Abstract

Background: In acute stroke, large vessel occlusion (LVO) should be promptly identified to guide patient's transportation directly to comprehensive stroke centers (CSC) for mechanical thrombectomy (MT). In many cases, prehospital multi-parameter scores are used by trained emergency teams to identify patients with high probability of LVO. However, in several countries, the first aid organization without intervention of skilled staff precludes the on-site use of such scores. Here, we assessed the accuracy of LVO prediction using a single parameter (i.e. complete hemiplegia) obtained by bystander's telephone-based witnessing.

Patients and methods: This observational, single-center study included consecutive patients who underwent intravenous thrombolysis at the primary stroke center and/or were directly transferred to a CSC for MT, from January 1, 2015 to March 1, 2020. We defined two groups: patients with initial hemiplegia (no movement in one arm and leg and facial palsy) and patients without initial hemiplegia, on the basis of a bystander's witnessing.

Results: During the study time, 874 patients were included [mean age 73 years (SD 13.8), 56.7% men], 320 with initial hemiplegia and 554 without. The specificity of the hemiplegia criterion to predict LVO was 0.88, but its sensitivity was only 0.53.

Conclusion: Our results suggest that the presence of hemiplegia as witnessed by a bystander can predict LVO with high specificity. This single criterion could be used for decision-making about direct transfer to CSC for MT when the absence of emergency skilled staff precludes the patient's on-site assessment, especially in regions distant from a CSC.

Keywords: Pre-hospital triage; Stroke management; Stroke unit; Thrombectomy.

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