| Background: Acute Ihemist Stroke(AIS)is a common and frequently-occurring disease in middle-aged and elderly people,and its incidence tends to be younger,making it the number one killer of human health.Acute Large Vessel Occlusion Stroke(ALVOS)has higher disability and mortality,and often has a poor prognosis.Recombinant tissue plasminogen activator(rt-pa)intravenous thrombolysis is the main treatment for vascular access in the past 10 years.Recombinant tissue plasminogen activator(rt-pa)intravenous thrombolysis is the main treatment for vascular access in the past 10 years.However,its narrow time window and low open blood vessel rate have forced neurologists to explore more effective treatments.Five positive RCT trials for endovascular treatment in 2014-2015 have been published,and the results confirm that endovascular treatment of ALVOS patients can benefit,and the treatment of patients with ALVOS becomes feasible.The time window of AIS treatment is narrower.The earlier the treatment,the higher the chance of opening the blood vessel,the more likely it is to save the brain tissue of the ischemic penumbra,and the prognosis is better.Emergency medical service(EMS)is the pioneer of stroke diagnosis and treatment.Pre-hospital emergency personnel use stroke scale to quickly identify patients with AIS,accurately and efficiently evaluate Large Vessel Occlusion(LVO)for the first diagnosis of stroke,The development of patient transport and treatment options is of great value.At present,there are many researches on the predictive value of AIS for stroke scales at home and abroad,but there are relatively few studies on thepredictive value of LVO using stroke scales,and the conclusions are not consistent.Objective: To investigate the relationship between the seven stroke scales and LVO,and to compare their predictive value for LVO.Methods: Registration of 114 patients who met the emergency neurology department of the Second Affiliated Hospital of Dalian Medical University from September 2016 to October 2018.Patients were scored using NIHSS score,CPSSS score,FAST-ED score,RACE score,PASS score,LAMS score,and 3-ISS score on 7 stroke scales.According to DSA or head and neck CTA to determine whether the large vessel occlusion,the patients were divided into large vascular occlusion group and non-macrovascular occlusion group.The ?2 test was used to compare NIHSS score,CPSSS score,FAST-ED score,RACE score,PASS score,3-ISS score,and LAMS score between the large vessel occlusion group and the non-vessel occlusion group,respectively,at P<0.05,the OR value >1 is statistically significant,and it is determined whether there is a relationship between each stroke scale and LVO.Receiver Operating Characteristic(ROC)is used to draw the ROC curve with 1-specificity as the abscissa and sensitivity as the ordinate.Finding the best cut-off point is the best cut-off value for predicting LVO.The area is the accuracy of predicting LVO,comparing the area under the curve of the seven stroke scales,and the specificity and sensitivity of the optimal cut point.Results: A total of 114 patients were enrolled in the study,including 77 males(70%)and 37 females(30%)aged 18-87 years.Among them,54 cases(47%)had large vessel occlusion and 60 cases(53%)had non-macrovascular occlusion.There were 45 cases of anterior circulation and 9 cases of posterior circulation.There were 29 cases of occlusion of the internal carotid artery,10 cases of occlusion of M1 segment of middle cerebral artery,3 cases of M2 segment occlusion of middle cerebral artery,3 cases of occlusion of M1 segment of middle cerebral artery in cerebral artery occlusion,7 cases of occlusion of base artery,vertebral artery There were 2 cases of V4 segment occlusion.(1)Univariate analysis of NIHSS scores.When the NIHSS score was ?5,the minimum value of OR was 12.1(95% CI 2.5-59.1),and the P value was <0.05,indicating that theNIHSS score was correlated with LVO.ROC curve analysis showed that the NIHSS score predicted an area under the ROC curve of LVO of 0.88,(95% CI 0.815 to 0.949).The optimal cutoff value of LVO is 8 points,and the sensitivity of LVO is 0.84 and the specificity is 0.83.(2)CPSSS score was analyzed by single factor analysis.When the CPSSS score was ?1,the minimum value of OR was 4.6(95% CI 1.2-18.0),and the P value was less than 0.05,suggesting that the CPSSS score was correlated with LVO.ROC curve analysis showed that the CPSSS score predicted the area under the ROC curve of LVO to be 0.81(95% CI0.713 to 0.862).It is judged that the optimal cutoff value of LVO is 2 points,and the sensitivity of predicting LVO is 0.70,and the specificity is 0.85.(3)FAST-ED score univariate analysis,when the FAST-ED score ? 4 points,the minimum value of OR was 6.9(95% CI 1.2-40.3),P value <0.05,indicating that the FAST-ED score has a significant correlation with LVO.ROC curve analysis showed that the FAST-ED score predicted an area under the ROC curve of LVO of 0.86(95% CI 0.782 to 0.929).The optimal cutoff value of LVO is 4 points,and the sensitivity of LVO is 0.78 and the specificity is 0.82.(4)Univariate analysis of RACE scores showed that when the RACE score was ?4,the minimum value of OR was 6.0(95%CI 0.9-37.2),and the maximum value of P was less than 0.05,indicating that RACE score was correlated with LVO.ROC curve analysis,RACE score predicted the area under the ROC curve of LVO was 0.85,(95% CI0.778-0.926).It is judged that the optimal cutoff value of LVO is 4 points,and the sensitivity of predicting LVO is 0.82,and the specificity is 0.76.(5)PASS score univariate analysis,when the PASS score ? 1 point,the minimum value of OR is 14.8(95% CI 9.7-52.4),P value is less than 0.05,suggesting that PASS score has a correlation with LVO.ROC curve analysis showed that the area under the ROC curve of the PASS score predicted LVO was 0.80(95% CI 0.757-0.911).It is judged that the optimal cutoff value of LVO is 2 points,and the sensitivity of predicting LVO is 0.64,and the specificity is 0.88.(6)Univariate analysis of 3-ISS scores.When the 3-ISS score was ? 2 points,therelative risk OR of the predicted LVO was 4.53(95CI 1.2-23.9),and the P value was less than 0.05,indicating 3-ISS score and LVO.Correlation.ROC curve analysis showed that the 3-ISS score predicted the area under the ROC curve of LVO to be 0.82(95% CI0.771 to 0.969).It is judged that the optimal cutoff value of LVO is 2 points,and the sensitivity of predicting LVO is 0.73,and the specificity is 0.85.(7)LAMS scores were analyzed by single factor analysis.When the LAMS score was ?2 points,the minimum value of OR was 8.84(95% CI 1.7-46.7),and the P value was<0.05,indicating that the LAMS score was correlated with LVO.ROC curve analysis showed that the LAMS score predicted an area under the ROC curve of LVO of 0.83(95% CI 0.761-0.923).The optimal cutoff value of LVO is 3 points,and the sensitivity of LVO is 0.74 and the specificity is 0.84.Conclusions:(1)NIHSS score,CPSSS score,FAST-ED score,RACE score,PASS score,3-ISS score,and LAMS score have predictive effects on LVO.(2)Compared with the other six stroke scales,the NIHSS score has the highest diagnostic value for LVO,but because of the cumbersome score,it is not necessarily the most convenient and efficient pre-hospital emergency stroke scale.(3)The FAST-ED score and the RACE score provide rapid and efficient identification of LVO patients with an accuracy comparable to NIHSS and have conditions for pre-hospital first aid stroke scales. |
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