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A potential method of identifying stroke and other intracranial lesions in a prehospital setting
Anssi Saviluoto1,2, Heini Harve-Rytsälä3, Mitja Lääperi4
1Research and Development Unit, FinnHEMS, WTC Helsinki Airport, Lentäjäntie 3, FI-01530, Vantaa, Finland. anssi.saviluoto@finnhems.fi.
Insights
A new scoring system using systolic blood pressure, heart rate, and age can help identify intracranial lesions in patients with decreased consciousness in prehospital settings. This tool aids in rapid diagnosis and treatment decisions for potential stroke or other brain injuries.
Area of Science:
- Emergency Medicine
- Neurology
- Clinical Diagnostics
Background:
- Prehospital identification of intracranial lesions in patients with decreased consciousness is challenging.
- Stroke and other intracranial pathologies require timely diagnosis and intervention.
Purpose of the Study:
- To evaluate the utility of combining systolic blood pressure, heart rate, and age for identifying intracranial lesions.
- To develop a decision instrument for prehospital use.
Main Methods:
- Retrospective case-control study of patients with decreased consciousness and secured airways.
- Analysis of systolic blood pressure, heart rate, and age in relation to final diagnoses.
- Development and validation of a scoring system based on these parameters.
Main Results:
- Higher systolic blood pressure (≥140 mmHg), lower heart rate (<100 bpm), and older age (>50 years) were significantly associated with intracranial lesions.
- The derived decision instrument demonstrated good diagnostic ability with an area under the receiver operating characteristic curve of 0.810.
- Specific odds ratios were calculated for different ranges of systolic blood pressure and age.
Conclusions:
- A simple instrument combining systolic blood pressure, heart rate, and age can effectively aid in identifying intracranial lesions in prehospital settings.
- This tool may improve the early detection of stroke and other neurological emergencies.
Background:
Identifying stroke and other intracranial lesions in patients with a decreased level of consciousness may be challenging in prehospital settings. Our objective was to investigate whether the combination of systolic blood pressure, heart rate and age could be used to identify intracranial lesions.
Methods:
We conducted a retrospective case-control study including patients with a decreased level of consciousness who had their airway secured during prehospital care. Patients with intracranial lesions were identified based on the final diagnoses at the end of hospitalization. We investigated the ability of systolic blood pressure, heart rate and age to identify intracranial lesions and derived a decision instrument.
Results:
Of 425 patients, 127 had an intracranial lesion. Patients with a lesion were characterized by higher systolic blood pressure, lower heart rate and higher age (P < 0.0001 for all). A systolic blood pressure ≥ 140 mmHg had an odds ratio (OR) of 3.5 (95% confidence interval [CI] 1.7 to 7.0), and > 170 mmHg had an OR of 8.2 (95% CI 4.5-15.32) for an intracranial lesion (reference: < 140 mmHg). A heart rate < 100 beats/min had an OR of 3.4 (95% CI 2.0 to 6.0, reference: ≥100). Age 50-70 had an OR of 4.1 (95% CI 2.0 to 9.0), and > 70 years had an OR of 10.2 (95% CI 4.8 to 23.2), reference: < 50. Logarithms of ORs were rounded to the nearest integer to create a score with 0-2 points for age and blood pressure and 0-1 for heart rate, with an increasing risk for an intracranial lesion with higher scores. The area under the receiver operating characteristics curve for the instrument was 0.810 (95% CI 0.850-0.890).
Conclusions:
An instrument combining systolic blood pressure, heart rate and age may help identify stroke and other intracranial lesions in patients with a decreased level of consciousness in prehospital settings.
Trial Registration:
Not applicable.
