[Predictive value of G-FAST score for acute anterior circulation stroke patients with large artery occlusion]

Objective: To investigate the accuracy of Gaze-face-arm-speech-time (G-FAST) score in the early diagnosis of acute anterior circulation stroke patients with large artery occlusion. Methods: A retrospective study was conducted to investigate the anterior circulation infarction (ACI) cases with complete vascular imaging data within 6 hours of onset in the Department of Neurology of Beijing Shijitan Hospital, Capital Medical University from May 2010 to April 2018. According to the results of digital subtraction angiography (DSA) or computed tomography angiography (CTA), the patients were divided into two groups: large artery occlusion group and non-large artery occlusion group. Accuracy of G-FAST score in predicting acute large artery occlusive stroke was analyzed by area under receiver operating characteristic curve (AUC). The predictive value of G-FAST score, National Institutes of Health Stroke Scale (NIHSS) score and Alberta stroke early CT score (ASPECTS) in predicting large artery occlusion was compared. Results: A total of 138 patients with acute anterior circulation ischemic stroke were included in the study, and 82 of them had large artery occlusion (59.4%). Univariate analysis showed that baseline NIHSS score (12.0 vs 8.9, P=0.000) and G-FAST score (3.1 vs 2.2, P=0.000) were significantly higher in patients with large artery occlusion than those without large artery occlusion, and ASPECTS was significantly lower than patients without large artery occlusion (7.4 vs 8.2, P=0.001). The results from ROC showed that G-FAST, NIHSS and ASPECTS were with the AUC of 0.781, 0.733 and 0.664, respectively. G-FAST score had the highest accuracy in predicting the anterior circulation arterial occlusion. The optimal threshold of G-FAST score was 2.5, with a sensitivity of 79.3% and a specificity of 64.3%. Further univariate analysis showed that percentage of large anterior vessel occlusion (LAVO) in G-FAST (≥3) group was significantly different from that in G-FAST (≤ 2) group [76.5%(65/85)∶32.1%(17/53), P=0.000]. Conclusions: G-FAST score has predictive value for acute anterior circulation arterial occlusive stroke. Endovascular treatment may need to consider in patients with high G-FAST score as early as possible when conditions permit.