DAFNES scale for large vessel occlusion in Ischemic Stroke : development and preliminary internal validation

Area of Science:

• Neurology
• Emergency Medicine
• Medical Diagnostics

Background:

• Timely identification of large vessel occlusion (LVO) in acute ischemic stroke is crucial for effective reperfusion therapy.
• Existing prehospital stroke scales often require bedside assessment, limiting their utility for telephone-based LVO recognition.

Purpose of the Study:

• To develop the DAFNES scale for LVO identification in suspected acute stroke patients.
• To conduct preliminary internal hospital-based validation of the DAFNES scale's performance.

Main Methods:

• A prospective observational study enrolled 408 patients with suspected stroke admitted to a tertiary hospital's Emergency Department.
• The DAFNES scale, comprising six binary items, was administered bedside by neurologists blinded to CT angiography results.
• LVO status was confirmed by a neurologist using CT angiography.

Main Results:

• The DAFNES scale demonstrated good discriminatory performance with an area under the curve of 0.79.
• At a cutoff score of ≥3, the scale achieved a sensitivity of 0.78 and specificity of 0.72.
• Median DAFNES scores were significantly higher in patients with LVO compared to those without.

Conclusions:

• The DAFNES scale shows promising discriminatory ability for LVO detection in hospital settings.
• Further validation studies are essential for prehospital and dispatcher-based implementation.
• The scale may aid in the early identification of stroke patients requiring urgent intervention.