Abstract
Background
In acute stroke, large vessel occlusion (LVO) should be promptly identified to guide patient’s transportation directly to comprehensive stroke centers (CSC) for mechanical thrombectomy (MT). In many cases, prehospital multi-parameter scores are used by trained emergency teams to identify patients with high probability of LVO. However, in several countries, the first aid organization without intervention of skilled staff precludes the on-site use of such scores. Here, we assessed the accuracy of LVO prediction using a single parameter (i.e. complete hemiplegia) obtained by bystander’s telephone-based witnessing.
Patients and methods
This observational, single-center study included consecutive patients who underwent intravenous thrombolysis at the primary stroke center and/or were directly transferred to a CSC for MT, from January 1, 2015 to March 1, 2020. We defined two groups: patients with initial hemiplegia (no movement in one arm and leg and facial palsy) and patients without initial hemiplegia, on the basis of a bystander’s witnessing.
Results
During the study time, 874 patients were included [mean age 73 years (SD 13.8), 56.7% men], 320 with initial hemiplegia and 554 without. The specificity of the hemiplegia criterion to predict LVO was 0.88, but its sensitivity was only 0.53.
Conclusion
Our results suggest that the presence of hemiplegia as witnessed by a bystander can predict LVO with high specificity. This single criterion could be used for decision-making about direct transfer to CSC for MT when the absence of emergency skilled staff precludes the patient’s on-site assessment, especially in regions distant from a CSC.
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Acknowledgements
We thank Anne Berteaux and Aurélie Cabaille for their contribution to data collection and Elisabetta Andermarcher for her revision of the manuscript.
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FL: conception and design of the work, analysis, interpretation of data, drafting, writing and final approval. TA, LVD, CJ, GF, AL, MI, PS, AD, MT, LNT, AO, SJ, ZMB, NO, FD, WC, BF, ML, JM, IM, AF-A, AD, J-CB, SA, LO: data collection, analysis, interpretation of data, drafting and final approval. CA, VC and AB: analysis, interpretation of data, drafting, writing and final approval. NG, GG, DH: analysis, interpretation of data, drafting and final approval. DS: conception and design of the work, data collection, analysis, interpretation of data, drafting, writing and final approval.
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The institutional ethics committees of Perpignan and Montpellier hospital approved this study which is in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
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Leibinger, F., Allou, T., Van Damme, L. et al. Usefulness of a single-parameter tool for the prediction of large vessel occlusion in acute stroke. J Neurol 268, 1358–1365 (2021). https://doi.org/10.1007/s00415-020-10286-8
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DOI: https://doi.org/10.1007/s00415-020-10286-8