Comparison Of Predictive Value Of Different Stroke Severity Scales For Large Vessel Occlusive Cerebral Infarction

ObjectiveThe purpose of this study was to analyze and compare the predictive value of 15 prehospital stroke severity score scales on Large Vessel Occlusion Stroke(LVOS),and selected the best prehospital scale that can predict LVOS quickly,simply and accurately is selected,which can provide valuable reference basis for early recognition,diagnosis and transshipment treatment of LVOS.MethodsThe research collected consecutive acute is chaemic stroke patients during the 2017.01 to 2020.01 in the first affiliated hospital of Xiamen university neurology hospital into the standard of diagnosis and treatment.Admission criteria and exclusion criteria should be met.Clinical and imaging data of the patients were collected.Calculate NIHSS、sNIHSS-EMS、sNIHSS-8、SAVE、EMSA、RACE、Pomona、FPSS、CG-FAST、PASS、CPSSS、C-STAT、LARIO、VAN and FAST PLUS Rating score.The Area under curve(AUC)and its 95%confidence interval(95%CI)were used to test the accuracy of LVOS prediction of each scale.The scale and the 95%CI under the boundary value of each scale were calculated.The 95%CI of the AUC≥0.80 is used as the evaluation index of high accuracy,and the 95%CI of sensitivity≥0.7 is used as the evaluation index of high sensitivity.Finally,the scoring methods and contents were compared,and the scale with simple and fast scoring method was selected as the final recommendation scale.Results1.A total of 910 patients were enrolled,including 208(22.9%)patients in the LVOS group.Among the 15 scales used to predict LVOS,the scales with AUC 95%CI lower limit≥0.80 and sensitivity of 95%CI lower limit≥0.70 included NIHSS,,sNIHSS-EMS、sNIHSS-8、EMSA、CPSSS and LARIO.NIHSS includes many items,sNIHSS-8 includes visual field assessment,LARIO scale includes neglect assessment,and each item of the sNIHSS-EMS score needed to be graded according to the severity of the disease,Therefore,EMSA and CPSSS were selected as the recommended scale for predicting LVOS.2.The AUC predicted by the 15 scales for posterior circulation Large Vessel Occlusion was significantly lower than that of anterior circulation Large Vessel Occlusion.In the prediction of large anterior vessel occlusion,NIHSS、sNIHSS-EMS、sNIHSS-8、LARIO、CPSSS and EMSA,the 95%CI of the AUC of EMSA and CPSSS are≥0.80.the sensitivity of 95%CI is≥0.7,EMSA and CPSSS are the most convenient evaluation methods.In the prediction of anterior circulation Large Vessel Occlusions,the 95%CI of the AUC of EMSA scale and CPSSS scale are≥0.80.the sensitivity of 95%CI is≥0.7.At the same time,the evaluation method is fast and simple.In the posterior circulation Large Vessel Occlusion,the lower limit of AUC 95%CI of any scale was not found to be≥0.80 and the lower limit of sensitivity 95%CI was≥0.70.Conclusion:1.The EMSA and CPSSS have the characteristics of high accuracy and sensitivity in the prediction of large vessel occlusion in acute ischemic stroke and the evaluation method is quick and simple.Therefore,the EMSA scale and CPSSS scale can be firstly recommended for the prediction.2.The accuracy of prediction of anterior circulation Large Vessel Occlusion in the 15 scales was significantly higher than that of posterior circulation Large Vessel Occlusion.In prediction of the anterior circulation Large Vessel Occlusion,EMSA and CPSSS still has high accuracy and sensitivity and assessment way and convenient advent-age in prediction of posterior circulation LVOS,In prediction of the posterior circulation Large Vessel Occlusion,sensitivity and accuracy are all scales do not meet expectations,the future for LVOS predictive scale needs to add more simplified and posterior circulation related projects.