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Multicenter Study
. 2021 Apr 26;13(10):13680-13692.
doi: 10.18632/aging.202910. Epub 2021 Apr 26.

Design and validation of a recognition instrument-the stroke aid for emergency scale-to predict large vessel occlusion stroke

Baorui Zhang  1   2   3 , Xiaochuan Huo  1   2   3 , Fei Yuan  1   2   3 , Guangrong Song  1   2   3 , Lang Liu  4 , Gaoting Ma  1   2   3 , Dapeng Mo  1   2   3 , Zhongxue Wu  1   2   3 , Zhongrong Miao  1   2   3 , Aihua Liu  1   2   3
Affiliations
Multicenter Study

Design and validation of a recognition instrument-the stroke aid for emergency scale-to predict large vessel occlusion stroke

Baorui Zhang et al. Aging (Albany NY). .

Abstract

Background and purpose: Rapidly recognizing patients with large-vessel occlusion stroke (LVOS) and transferring them to a center offering recanalization therapy is crucial of maximizing the benefits of early treatment. We therefore aimed to design an easy-to-use recognition instrument for identifying LVOS.

Methods: Prospective data were collected from emergency departments of 12 stroke-center hospitals in China during a 17-month study period. The Stroke Aid for Emergency (SAFE) scale is based on consciousness commands, facial palsy, gaze, and arm motor ability. Receiver operating characteristic analysis was used to obtain the area under the curve for the SAFE scale and previously established scales to predict LVOS.

Results: The SAFE scale could accurately predict LVOS at an accuracy rate comparable to that of the National Institutes of Health Stroke Scale (c-statistics: 0.823 versus 0.831, p = 0.4798). The sensitivity, specificity, positive predictive value, and negative predictive value for the SAFE scale were 0.6875, 0.8577, 0.6937, and 0.8542, respectively, with a cutoff point of 4. The SAFE scale also performed well in a subgroup analysis based on the patients' ages, occluded vessel locations, and the onset-to-door times.

Conclusions: The SAFE scale can accurately recognize LVOS at a rate comparable to those of other, similar scales.

Keywords: NIHSS; accuracy; endovascular therapy; large-vessel occlusion stroke; recognition instrument.

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Conflict of interest statement

CONFLICTS OF INTEREST: The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart of the study population. AIS: acute ischemic stroke; NIHSS, National Institutes of Health Stroke Scale; CTA: CT angiography; TOF-MRA: time-of-flight magnetic resonance angiography; AC: anterior circulation; PC: posterior circulation.
Figure 2
Figure 2
Receiver operating characteristic curves comparing the discrimination of NIHSS, SAFE, CPSSS, FAST-ED, RACE, and 3I-SS. (A) Receiver operating characteristic curves comparing the discrimination of SAFE, NIHSS, CPSSS, FAST-ED, RACE, and 3I-SS for the detection of large vessel occlusion strokes (all subjects). (B) Subjects with anterior circulation infarcts. (C) Subjects with posterior circulation infarcts. NIHSS: National Institutes of Health Stroke Scale; SAFE: Stroke Aid for Emergency Scale; CPSSS: Cincinnati Prehospital Stroke Severity Scale; FAST-ED: Field Assessment Stroke Triage for Emergency Destination scale; RACE: Rapid Arterial Occlusion Evaluation scale; 3I-SS: Three-Item Stroke Scale.
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