Deriving a Simple Clinical Predictive Score for Posterior Circulation Ischemic Stroke (PCS-SCORE)

Area of Science:

• Neurology
• Clinical Diagnostics
• Stroke Medicine

Background:

• Posterior circulation ischemic stroke (PCS) is underdiagnosed due to atypical symptoms.
• Early detection of PCS is crucial but challenging.
• Conventional stroke scales often fail to adequately represent PCS.

Purpose of the Study:

• To develop a pragmatic clinical scoring tool, the PCS-SCORE.
• To identify patients at high risk of PCS using bedside features.
• To improve early recognition of posterior circulation ischemic stroke.

Main Methods:

• Retrospective analysis of 5163 patients from a stroke registry (1571 with confirmed PCS).
• Identification of key predictors using multivariable logistic regression and lasso modeling.
• Development of the PCS-SCORE (0-9 points) based on weighted variables: diabetes, hypertension, male sex, double/blurred vision, vertigo with vomiting, and incoordination.

Main Results:

• The PCS-SCORE demonstrated an AUC of 0.76 at a threshold >3 (87.9% specificity, 43.4% sensitivity).
• Increasing the threshold to >4 improved specificity to 94.4% (sensitivity 27.9%).
• Higher scores correlated with an increased likelihood of PCS, aiding risk identification.

Conclusions:

• The PCS-SCORE is a simple, highly specific bedside tool for early detection of posterior circulation strokes.
• Its rule-in strength is valuable in prehospital and emergency settings.
• Prospective validation of the PCS-SCORE is currently underway.