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Prediction of acute neurovascular syndromes with prehospital clinical features witnessed by bystanders

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Abstract

Background

The prompt recognition of an acute neurovascular syndrome by the patient or a bystander witnessing the event can directly influence outcome. We aimed to study the predictive value of the medical history and clinical features recognized by the patients’ bystanders to preclassify acute stroke syndromes in prehospital settings.

Methods

We analyzed 369 patients: 209 (56.6%) with acute ischemic stroke (AIS), 107 (29.0%) with intracerebral hemorrhage (ICH), and 53 (14.4%) with subarachnoid hemorrhage (SAH). All patients had neuroimaging as diagnostic gold standard. We constructed clinical prediction rules (CPRs) with features recognized by the bystanders witnessing the stroke onset to classify the acute neurovascular syndromes before final arrival to the emergency room (ER).

Results

In all, 83.2% cases were referred from other centers, and only 16.8% (17.2% in AIS, 15% in ICH, and 18.9% in SAH) had direct ER arrival. The time to first assessment in ≤ 3 h occurred in 72.4% (73.7%, 73.8%, and 64.2%, respectively), and final ER arrival in ≤ 3 h occurred in 26.8% (32.1%, 15.9%, and 28.3%, respectively). Clinical features referred by witnesses had low positive predictive values (PPVs) for stroke type prediction. Language or speech disorder + focal motor deficit showed 63.3% PPV, and 77.0% negative predictive value (NPV) for predicting AIS. Focal motor deficit + history of hypertension had 35.9% PPV and 78.8% NPV for ICH. Headache alone had 27.9% PPV and 95.3% NPV for SAH. In multivariate analyses, seizures, focal motor deficit, and hypertension increased the probability of a time to first assessment in ≤ 3 h, while obesity was inversely associated. Final ER arrival was determined by age and a direct ER arrival without previous referrals.

Conclusion

CPRs constructed with the witnesses’ narrative had only adequate NPVs in the prehospital classification of acute neurovascular syndromes, before neuroimaging confirmation.

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Authors and Affiliations

  1. Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15, Col. Sección XVI Belisario Domínguez, Tlalpan, C. P, 14080, Ciudad de México, Mexico

    Erwin Chiquete, Amado Jiménez-Ruiz, Miguel García-Grimshaw, Rogelio Domínguez-Moreno, Elizabeth Rodríguez-Perea, Paola Trejo-Romero, Eduardo Ruiz-Ruiz, Valeria Sandoval-Rodríguez, Juan José Gómez-Piña, Guillermo Ramírez-García, Liz Toapanta-Yanchapaxi, Fernando Flores-Silva & Carlos Cantú-Brito

  2. Unidad de Biología Molecular, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico

    Ana Ochoa-Guzmán

  3. Servicio de Neurología, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico

    José Luis Ruiz-Sandoval

  4. Departamento de Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico

    José Luis Ruiz-Sandoval

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  1. Erwin Chiquete
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  2. Amado Jiménez-Ruiz
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  3. Miguel García-Grimshaw
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  4. Rogelio Domínguez-Moreno
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  8. Valeria Sandoval-Rodríguez
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  9. Juan José Gómez-Piña
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  14. José Luis Ruiz-Sandoval
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  15. Carlos Cantú-Brito
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Corresponding author

Correspondence to Carlos Cantú-Brito.

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NER-1230-14/15-1, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán.

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Informed consent was signed by the patients or their legal proxies at hospital admission.

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Chiquete, E., Jiménez-Ruiz, A., García-Grimshaw, M. et al. Prediction of acute neurovascular syndromes with prehospital clinical features witnessed by bystanders. Neurol Sci 42, 3217–3224 (2021). https://doi.org/10.1007/s10072-020-04929-x

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