Revisiting the NIH Stroke Scale as a screening tool for proximal vessel occlusion: can advanced imaging be targeted in acute stroke?

Journal of Neurointerventional Surgery
Ryan D MooreBlaise Baxter

Abstract

Most patients with stroke-like symptoms screened by advanced imaging for proximal occlusion will not have a thrombus accessible by neurointerventional techniques. Development of a sensitive clinical scoring system for rapidly identifying patients with an emergent large vessel occlusion could help target limited resources and reduce exposure to unnecessary imaging. This historical cohort study included patients who underwent non-contrast CT and CT angiography in the emergency department for stroke-like symptoms. NIH Stroke Scale (NIHSS) criteria were extended to include resolved symptoms and dichotomized as present or absent. Combinations of NIHSS criteria were considered as tests for proximal occlusion. Proximal cerebral vascular occlusion was present in 19.2% (100/522) of the population and, of these, 13% (13/100) had an NIHSS score of 0. The presence on examination or history of diminished consciousness with inability to answer questions, leg weakness, dysarthria, or gaze deviation had 96% sensitivity and 39% specificity for proximal occlusion. If implemented in this population, the use of CT angiography would have been decreased by 32.4% (169/522 patients) while missing 0.76% with proximal occlusions (4/522). Half of those m...Continue Reading

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Citations

Nov 9, 2016·Current Atherosclerosis Reports·Jessica HurtubiseJoseph Fomusi Ndisang
Jun 4, 2020·Stroke; a Journal of Cerebral Circulation·Gauthier DuloquinYannick Béjot
Sep 6, 2019·BMC Emergency Medicine·Daria AntipovaPhilip Wilson
May 3, 2018·Interventional Neurology·Kessarin PanichpisalNazli Janjua

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