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. 2024 Mar;55(3):548-554.
doi: 10.1161/STROKEAHA.123.044898. Epub 2024 Feb 1.

Sex Differences in Prehospital Identification of Large Vessel Occlusion in Patients With Suspected Stroke

Mariam Ali  1 , Luuk Dekker  1 , Jasper D Daems  2   3 , Mahsoem Ali  4 , Erik W van Zwet  5 , Ewout W Steyerberg  5 , Martijne H C Duvekot  2   6 , T Truc My Nguyen  1 , Walid Moudrous  7 , Ruben M van de Wijdeven  2 , Marieke C Visser  8   9 , Karlijn F de Laat  10 , Henk Kerkhoff  6 , Ido R van den Wijngaard  1   11   12 , Diederik W J Dippel  2 , Bob Roozenbeek  2 , Nyika D Kruyt  1   12 , Marieke J H Wermer  1   13 ; LPSS and PRESTO Investigators
Collaborators, Affiliations

Sex Differences in Prehospital Identification of Large Vessel Occlusion in Patients With Suspected Stroke

Mariam Ali et al. Stroke. 2024 Mar.

Abstract

Background: Differences in clinical presentation of acute ischemic stroke between men and women may affect prehospital identification of anterior circulation large vessel occlusion (aLVO). We assessed sex differences in diagnostic performance of 8 prehospital scales to detect aLVO.

Methods: We analyzed pooled individual patient data from 2 prospective cohort studies (LPSS [Leiden Prehospital Stroke Study] and PRESTO [Prehospital Triage of Patients With Suspected Stroke Study]) conducted in the Netherlands between 2018 and 2019, including consecutive patients ≥18 years suspected of acute stroke who presented within 6 hours after symptom onset. Ambulance paramedics assessed clinical items from 8 prehospital aLVO detection scales: Los Angeles Motor Scale, Rapid Arterial Occlusion Evaluation, Cincinnati Stroke Triage Assessment Tool, Cincinnati Prehospital Stroke Scale, Prehospital Acute Stroke Severity, gaze-face-arm-speech-time, Conveniently Grasped Field Assessment Stroke Triage, and Face-Arm-Speech-Time Plus Severe Arm or Leg Motor Deficit. We assessed the diagnostic performance of these scales for identifying aLVO at prespecified cut points for men and women.

Results: Of 2358 patients with suspected stroke (median age, 73 years; 47% women), 231 (10%) had aLVO (100/1114 [9%] women and 131/1244 [11%] men). The area under the curve of the scales ranged from 0.70 (95% CI, 0.65-0.75) to 0.77 (95% CI, 0.73-0.82) in women versus 0.69 (95% CI, 0.64-0.73) to 0.75 (95% CI, 0.71-0.79) in men. Positive predictive values ranged from 0.23 (95% CI, 0.20-0.27) to 0.29 (95% CI, 0.26-0.31) in women versus 0.29 (95% CI, 0.24-0.33) to 0.37 (95% CI, 0.32-0.43) in men. Negative predictive values were similar (0.95 [95% CI, 0.94-0.96] to 0.98 [95% CI, 0.97-0.98] in women versus 0.94 [95% CI, 0.93-0.95] to 0.96 [95% CI, 0.94-0.97] in men). Sensitivity of the scales was slightly higher in women than in men (0.53 [95% CI, 0.43-0.63] to 0.76 [95% CI, 0.68-0.84] versus 0.49 [95% CI, 0.40-0.57] to 0.63 [95% CI, 0.55-0.73]), whereas specificity was lower (0.79 [95% CI, 0.76-0.81] to 0.87 [95% CI, 0.84-0.89] versus 0.82 [95% CI, 0.79-0.84] to 0.90 [95% CI, 0.88-0.91]). Rapid arterial occlusion evaluation showed the highest positive predictive values in both sexes (0.29 in women and 0.37 in men), reflecting the different event rates.

Conclusions: aLVO scales show similar diagnostic performance in both sexes. The rapid arterial occlusion evaluation scale may help optimize prehospital transport decision-making in men as well as in women with suspected stroke.

Keywords: acute ischemic stroke; emergency medical services; large vessel occlusion; sex; thrombectomy.

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Conflict of interest statement

Disclosures Dr Wermer reports receiving Clinical Established Investigator grant 2016T086 from the Dutch Heart Foundation and VIDI grant 9171337 from the Netherlands Organization for Health Research and Development (ZonMw) during the conduct of the original LPSS (Leiden Prehospital Stroke Study). Dr Kruyt reports receiving grant HA20 15.01.02 from the Dutch Brain Foundation, grant 3.240 from the Dutch Innovation Funds, and grant LSHM16041 from Health-Holland during the conduct of the study. Dr Roozenbeek reports funding from the Dutch Heart Foundation and the Netherlands Organization for Health Research and Development (ZonMw) during the conduct of this study, paid to the institution. Dr Dippel reports funding from the Dutch Heart Foundation, Brain Foundation Netherlands, the Netherlands Organisation for Health Research and Development, Health-Holland Top Sector Life Sciences & Health, and unrestricted grants from Penumbra Inc, Stryker, Medtronic, Thrombolytic Science, LLC, and Cerenovus for research, all paid to institution outside the submitted work. Dr van den Wijngaard reports compensation from Philips for consultant services, compensation from Medtronic for consultant services, and stock holdings in Neurophyxia BV. The other authors report no conflicts.

Figures

Figure.
Figure.
Flow diagram of patients in the LPSS (Leiden Prehospital Stroke Study) and PRESTO study (Prehospital Triage of Patients With Suspected Stroke).
See this image and copyright information in PMC

Comment in

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