Comparing validated stroke screening scales for identifying large and medium vessel occlusions: a prospective...

Area of Science:

• Neurology
• Emergency Medicine
• Stroke Diagnostics

Background:

• Prehospital identification of acute ischemic stroke with large vessel occlusions (AIS-LVO) is crucial for timely treatment.
• Stroke screening scale utilization in clinical practice is inconsistent.
• Comparing scales for detecting anterior/posterior circulation AIS-LVO and AIS with medium vessel occlusions (AIS-MeVO) is needed.

Purpose of the Study:

• To prospectively compare the diagnostic performance of eight stroke screening scales.
• To evaluate the detection rates of AIS-LVO and AIS-MeVO using various scales.
• To determine if any single scale demonstrates superior efficacy in identifying critical stroke types.

Main Methods:

• Prospective analysis of 198 stroke alert activations from August 2022 to December 2023.
• Application of eight stroke screening scales: BE-FAST, LAMS, PASS, FAST-ED, EMS RACE, 3-ISS, VAN, and NIHSS.
• Final diagnosis classification into AIS-LVO/MeVO, AIS without major occlusion, intracranial hemorrhage, TIA, or stroke mimic.

Main Results:

• The LAMS scale demonstrated the highest performance (AUC 0.750), closely followed by FAST-ED (AUC 0.736) and VAN (AUC 0.735).
• Optimal cut-off points were identified for LAMS (3), FAST-ED (3), and VAN (positive).
• Despite performance differences, the study found non-significant variations among the scales.

Conclusions:

• This is the first prospective study comparing eight stroke screening scales for AIS-LVO and AIS-MeVO detection.
• LAMS, FAST-ED, and VAN showed comparable discriminative ability.
• The findings support existing literature suggesting similar performance among validated stroke screening scales, with no single scale being definitively superior.