Design and validation of a new scale for prehospital evaluation of stroke and large vessel occlusion

Yanqi Shao; Zheyu Zhang; Bo Jin; Jingsi Xu; Deqing Peng; Yu Geng; Jungen Zhang; Sheng Zhang

doi:10.1177/17562864221104511

Design and validation of a new scale for prehospital evaluation of stroke and large vessel occlusion

Ther Adv Neurol Disord. 2022 Jun 30:15:17562864221104511. doi: 10.1177/17562864221104511. eCollection 2022.

Authors

Yanqi Shao¹, Zheyu Zhang¹, Bo Jin¹, Jingsi Xu², Deqing Peng³, Yu Geng¹, Jungen Zhang⁴, Sheng Zhang⁵

Affiliations

¹ Center for Rehabilitation Medicine, Department of Neurology, People's Hospital of Hangzhou Medical College, Zhejiang Provincial People's Hospital, Hangzhou, China.
² The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China.
³ Center for Rehabilitation Medicine, Department of Neurosurgery, People's Hospital of Hangzhou Medical College, Zhejiang Provincial People's Hospital, Hangzhou, China.
⁴ Hangzhou Emergency Medical Center of Zhejiang Province, Hangzhou, China.
⁵ Center for Rehabilitation Medicine, Department of Neurology, People's Hospital of Hangzhou Medical College, Zhejiang Provincial People's Hospital, 158# Shangtang Road, Hangzhou 310014, Zhejiang, China.

Abstract

Background: Rapid recognition of acute stroke and large vessel occlusion (LVO) is essential in prehospital triage for timely reperfusion treatment.

Objective: This study aimed to develop and validate a new screening tool for both stroke and LVO in an urban Chinese population.

Methods: This study included patients with suspected stroke who were transferred to our hospital by emergency medical services between July 2017 and June 2021. The population was randomly partitioned into training (70%) and validation (30%) groups. The Staring-Hypertension-atrIal fibrillation-sPeech-weakneSs (SHIPS) scale, consisting of both clinical and medical history information, was generated based on multivariate logistic models. The predictive ability of the SHIPS scale was evaluated and compared with other scales using receiver operating characteristic (ROC) curve comparison analysis.

Results: A total of 400 patients were included in this analysis. In the training group (n = 280), the SHIPS scale showed a sensitivity of 90.4% and specificity of 60.8% in predicting stroke and a sensitivity of 75% and specificity of 61.5% in predicting LVO. In the validation group (n = 120), the SHIPS scale was not inferior to Stroke 1-2-0 (p = 0.301) in predicting stroke and was significantly better than the Cincinnati Stroke Triage Assessment Tool (C-STAT; formerly CPSSS) and the Prehospital Acute Stroke Severity scale (PASS) (all p < 0.05) in predicting LVO. In addition, including medical history in the scale was significantly better than using symptoms alone in detecting stroke (training group, 0.853 versus 0.818; validation group, 0.814 versus 0.764) and LVO (training group, 0.748 versus 0.722; validation group, 0.825 versus 0.778).

Conclusion: The SHIPS scale may serve as a superior screening tool for stroke and LVO identification in prehospital triage. Including medical history in the SHIPS scale improves the predictive value compared with clinical symptoms alone.

Keywords: China; acute stroke; large vessel occlusion; retrospective study.