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Early stroke recognition: developing an out-of-hospital NIH Stroke Scale
1Department of Emergency Medicine, University of Cincinnati Medical Center, OH 45267-0769, USA. rashmikant.kothari@uc.edu
Summary
A new Out-of-hospital NIH Stroke Scale using three key symptoms accurately identifies stroke patients. This abbreviated scale aids emergency medical services in rapid stroke detection and triage.
Area of Science:
- Neurology
- Emergency Medicine
- Clinical Diagnostics
Background:
- Rapid identification of stroke is critical for effective treatment and improved patient outcomes.
- Existing neurologic scales can be time-consuming for pre-hospital or emergency department (ED) use.
- Development of a streamlined scale is needed for emergency medical services (EMS) and triage personnel.
Purpose of the Study:
- To develop a practical, abbreviated neurologic scale for identifying potential stroke patients.
- To create a tool assisting EMS and triage staff in stroke patient recognition.
Main Methods:
- Prospective, observational cohort study involving 74 stroke patients and 225 non-stroke patients in university-based EDs.
- Modification and binomial recoding of the National Institutes of Health (NIH) Stroke Scale items.
- Univariate analyses and recursive partitioning to develop a predictive decision rule for stroke.
Main Results:
- Three items—facial palsy, motor arm, and dysarthria—identified 100% of stroke patients.
- An Abbreviated NIH Stroke Scale achieved 100% sensitivity and 92% specificity.
- A proposed Out-of-hospital NIH Stroke Scale demonstrated 100% sensitivity and 88% specificity.
Conclusions:
- The proposed Out-of-hospital NIH Stroke Scale demonstrates high sensitivity and specificity for stroke identification in ED patients.
- This abbreviated scale shows promise for use by physicians in identifying stroke.
- Further prospective studies are required to validate the scale's utility by other healthcare professionals in out-of-hospital settings.