Severity Scale May Improve Prediction Of Large Vessel Occlusion In Anterior Circulation

Background and PurposesWe aim to modified Cincinnati Prehospital Stroke Severity Scale(CPSSS)with atrial fibrillation(AF),and evaluate the ability of modified CPSSS(mCPSSS)for prediction of large vessel occlusion(LVO)of anterior circulation.MethodsDuring May 2019 and April 2020,we retrospectively analyzed the clinical data of acute ischemic stroke patients in comprehensive stroke center,Yongchuan Hospital of Chongqing Medical University.Univariate analysis and Binary logistic regression analysis were used to analyze the the association of CPSSS item and AF with LVO.Receiver operating characteristic(ROC)curve and areas under curve(AUC)were used as a measure of predictive ability for large vessel occlusion of the mCPSSS scale and other common scales.The statistical significance of the discriminative difference between scales was tested with the De Long’s test.ResultsA total of 263 patients were included in the study.Gaze deviation,arm paresis,consciousness commands and questions,and AF were significant independent predictors of LVO.ROC curve demonstrated that the optimal value of atrial fibrillation was 1 point,for it possessed significantly higher areas under curve(AF=1,AUC=0.943;AF=2,AUC=0.937).For mCPSSS,the optimal cut-off value for large vessel occlusion was 2,and the areas under curve was 0.955,with a sensitivity of 90.16% and a specificity of 94.33%.The De Long’s test indicated that discrimination was significantly better than or not different from that of other common scales.ConclusionsThe mCPSSS is simple,quick,easy to perform and highly accurate,which may be used to identify LVO of anterior circulation patients in pre-hospital emergency and in-hospital triagement.