Prehospital Prediction of Large Vessel Occlusion in Suspected Stroke Patients

Current Atherosclerosis Reports
Kevin J KeenanJason T McMullan

Abstract

Recent advances in endovascular thrombectomy have made acute ischemic stroke due to a large vessel occlusion more treatable than ever. Rapid access to treatment remains paramount and multiple large vessel occlusion prediction scales have been created to enhance prehospital identification and triage of these patients. This review summarizes the current state of large vessel occlusion prediction scales, proposes a set of ideal scale features, and discusses the future of these scales and prehospital neurological emergency response systems. A meta-analysis of the available data concluded that none of the currently published scales are more accurate than the others. However, other studies provide insight into important qualitative features beyond accuracy. At present, only a few large vessel occlusion prediction scales have been studied in the necessary prehospital suspected stroke patient population. Among these small studies, 26-51% of patients identified by scales had large vessel occlusions and 63-84% qualified for triage to a Comprehensive Stroke Center. Valuable scale features include binary scoring, inclusion of gaze deviation and arm weakness, exclusion of neglect, and prehospital validation in a suspected stroke cohort. Pat...Continue Reading

References

Jun 1, 1989·Archives of Neurology·L B GoldsteinJ N Davis
Nov 1, 1994·Stroke; a Journal of Cerebral Circulation·P LydenJ Marler
Mar 27, 1999·Annals of Emergency Medicine·R U KothariJ Broderick
Jan 8, 2000·Stroke; a Journal of Cerebral Circulation·C S KidwellJ L Saver
Dec 7, 2002·Stroke; a Journal of Cerebral Circulation·David L TirschwellLewis B Morgenstern
Dec 24, 2003·Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors·Jennifer N LlanesJeffrey L Saver
Sep 10, 2005·Stroke; a Journal of Cerebral Circulation·Urs FischerHeinrich P Mattle
Aug 5, 2006·Cerebrovascular Diseases·S Andrew JosephsonS Claiborne Johnston
Jun 17, 2008·Stroke; a Journal of Cerebral Circulation·Bijen NazlielJeffrey L Saver
Oct 17, 2008·Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors·Abdul R AbdullahLee H Schwamm
Jul 18, 2009·Stroke; a Journal of Cerebral Circulation·Matthew B MaasWade S Smith
Sep 1, 2009·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·Alexa N RichieUNKNOWN SWISS Group
Jul 29, 2010·Circulation. Cardiovascular Quality and Outcomes·Thomas W ConcannonHarry P Selker
Dec 22, 2010·Archives of Surgery·Marie L CrandallFrederick A Luchette
Apr 30, 2011·Stroke; a Journal of Cerebral Circulation·Shyam PrabhakaranThomas P Bleck
Jul 13, 2012·Circulation. Cardiovascular Quality and Outcomes·Cheryl B LinGregg C Fonarow
Mar 9, 2013·Stroke; a Journal of Cerebral Circulation·Mirjam R HeldnerUrs Fischer
Nov 28, 2013·Stroke; a Journal of Cerebral Circulation·Natalia Pérez de la OssaAntoni Dávalos
May 23, 2014·Neurology·Ethan S BrandlerSteven R Levine
Feb 5, 2015·The New England Journal of Medicine·Jeffrey L SaverUNKNOWN FAST-MAG Investigators and Coordinators
Apr 23, 2015·Stroke; a Journal of Cerebral Circulation·Brian S KatzJoseph P Broderick
Dec 8, 2015·Current Opinion in Neurology·Charles KircherOpeolu Adeoye
Feb 9, 2016·Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors·Evan HodellPrasanthi Govindarajan
Mar 14, 2016·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·Benjamin R KummerBabak B Navi
Mar 14, 2016·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·Robert L DicksonJennifer Reeves
Jun 9, 2016·Stroke; a Journal of Cerebral Circulation·Sidsel HastrupGrethe Andersen
Jun 28, 2016·Journal of Neurointerventional Surgery·Syed F ZaidiMouhammad A Jumaa
Sep 28, 2016·JAMA : the Journal of the American Medical Association·Jeffrey L SaverUNKNOWN HERMES Collaborators
Oct 11, 2016·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·David CarreraNatalia Pérez de la Ossa
Oct 26, 2016·Stroke; a Journal of Cerebral Circulation·Natalia Pérez de la OssaSònia Abilleira
Jan 15, 2017·Stroke; a Journal of Cerebral Circulation·Joon-Tae KimUNKNOWN FAST-MAG Trial (Field Administration of Stroke Therapy–Magnesium) Nurse-Coordinators and Investigators
Jan 26, 2017·Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors·Jason T McMullanOpeolu Adeoye
Apr 16, 2017·Stroke; a Journal of Cerebral Circulation·Raul G NogueiraMichael R Frankel
Apr 23, 2017·Neurology·Tobias BobingerMartin Köhrmann
May 2, 2017·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·Jelle DemeestereChristopher Levi
Sep 4, 2017·Journal of the American College of Surgeons·Benjamin MartinezJohn P Hunt
Nov 14, 2017·The New England Journal of Medicine·Raul G NogueiraUNKNOWN DAWN Trial Investigators
Jan 25, 2018·The New England Journal of Medicine·Gregory W AlbersUNKNOWN DEFUSE 3 Investigators

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Citations

Jan 26, 2020·Neurology·Jorge Rodríguez-PardoUNKNOWN Madrid Stroke Network Study Group
Mar 7, 2019·Neurotherapeutics : the Journal of the American Society for Experimental NeuroTherapeutics·Wade S Smith
Feb 6, 2020·Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors·Remle P CroweJason T McMullan
Dec 12, 2019·Current Treatment Options in Cardiovascular Medicine·Julian MaingardThabele M Leslie-Mazwi
Jan 4, 2021·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·Benedikt JohannesArno Reich
Apr 25, 2021·Journal of Neurointerventional Surgery·Mehul D PatelOmar Kass-Hout

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