Cargando…
Prehospital Identification of Large Vessel Occlusions Using Modified National Institutes of Health Stroke Scale: A Pilot Study
Stroke identification is a key step in acute ischemic stroke management. Our objectives were to prospectively examine the agreement between prehospital and hospital Modified National Institutes of Health Stroke Scale (mNIHSS) assessments as well as assess the prehospital performance characteristics...
Autores principales: | , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8162654/ https://www.ncbi.nlm.nih.gov/pubmed/34054691 http://dx.doi.org/10.3389/fneur.2021.643356 |
_version_ | 1783700762195394560 |
---|---|
author | Mulkerin, William D. Spokoyny, Ilanit Francisco, Jonathan T. Lima, Brandon Corry, Megan D. Nudelman, Matthew J. R. Niknam, Kian Brown, Ian P. Kohn, Michael A. Govindarajan, Prasanthi |
author_facet | Mulkerin, William D. Spokoyny, Ilanit Francisco, Jonathan T. Lima, Brandon Corry, Megan D. Nudelman, Matthew J. R. Niknam, Kian Brown, Ian P. Kohn, Michael A. Govindarajan, Prasanthi |
author_sort | Mulkerin, William D. |
collection | PubMed |
description | Stroke identification is a key step in acute ischemic stroke management. Our objectives were to prospectively examine the agreement between prehospital and hospital Modified National Institutes of Health Stroke Scale (mNIHSS) assessments as well as assess the prehospital performance characteristics of the mNIHSS for identification of large vessel occlusion strokes. Method: In this prospective cohort study conducted over a 20-month period (11/2016–6/2018), we trained 40 prehospital providers (paramedics) in Emergency Neurological Life Support (ENLS) curriculum and in mNIHSS. English-speaking patients aged 18 and above transported for an acute neurological deficit were included. Using unique identifiers, we linked the prehospital assessment records to the hospital record. We calculated the agreement between prehospital and hospital mNIHSS scores using the Bland-Altman analysis and the sensitivity and specificity of the prehospital mNIHSS. Results: Of the 31 patients, the mean difference (prehospital mNIHSS—hospital mNIHSS) was 2.4, 95% limits of agreement (−5.2 to 10.0); 10 patients (32%) met our a priori imaging definition of large vessel occlusion and the sensitivity of mNIHSS ≥ 8 was 6/10 or 0.60 (95% CI: 0.26–0.88) and the specificity was 13/21 or 0.62 (95% CI: 0.38–0.82), respectively. Conclusions: We were able to train prehospital providers to use the prehospital mNIHSS. Prehospital and hospital mNIHSS had a reasonable level of agreement and and the scale was able to predict large vessel occlusions with moderate sensitivity. |
format | Online Article Text |
id | pubmed-8162654 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-81626542021-05-29 Prehospital Identification of Large Vessel Occlusions Using Modified National Institutes of Health Stroke Scale: A Pilot Study Mulkerin, William D. Spokoyny, Ilanit Francisco, Jonathan T. Lima, Brandon Corry, Megan D. Nudelman, Matthew J. R. Niknam, Kian Brown, Ian P. Kohn, Michael A. Govindarajan, Prasanthi Front Neurol Neurology Stroke identification is a key step in acute ischemic stroke management. Our objectives were to prospectively examine the agreement between prehospital and hospital Modified National Institutes of Health Stroke Scale (mNIHSS) assessments as well as assess the prehospital performance characteristics of the mNIHSS for identification of large vessel occlusion strokes. Method: In this prospective cohort study conducted over a 20-month period (11/2016–6/2018), we trained 40 prehospital providers (paramedics) in Emergency Neurological Life Support (ENLS) curriculum and in mNIHSS. English-speaking patients aged 18 and above transported for an acute neurological deficit were included. Using unique identifiers, we linked the prehospital assessment records to the hospital record. We calculated the agreement between prehospital and hospital mNIHSS scores using the Bland-Altman analysis and the sensitivity and specificity of the prehospital mNIHSS. Results: Of the 31 patients, the mean difference (prehospital mNIHSS—hospital mNIHSS) was 2.4, 95% limits of agreement (−5.2 to 10.0); 10 patients (32%) met our a priori imaging definition of large vessel occlusion and the sensitivity of mNIHSS ≥ 8 was 6/10 or 0.60 (95% CI: 0.26–0.88) and the specificity was 13/21 or 0.62 (95% CI: 0.38–0.82), respectively. Conclusions: We were able to train prehospital providers to use the prehospital mNIHSS. Prehospital and hospital mNIHSS had a reasonable level of agreement and and the scale was able to predict large vessel occlusions with moderate sensitivity. Frontiers Media S.A. 2021-05-14 /pmc/articles/PMC8162654/ /pubmed/34054691 http://dx.doi.org/10.3389/fneur.2021.643356 Text en Copyright © 2021 Mulkerin, Spokoyny, Francisco, Lima, Corry, Nudelman, Niknam, Brown, Kohn and Govindarajan. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Neurology Mulkerin, William D. Spokoyny, Ilanit Francisco, Jonathan T. Lima, Brandon Corry, Megan D. Nudelman, Matthew J. R. Niknam, Kian Brown, Ian P. Kohn, Michael A. Govindarajan, Prasanthi Prehospital Identification of Large Vessel Occlusions Using Modified National Institutes of Health Stroke Scale: A Pilot Study |
title | Prehospital Identification of Large Vessel Occlusions Using Modified National Institutes of Health Stroke Scale: A Pilot Study |
title_full | Prehospital Identification of Large Vessel Occlusions Using Modified National Institutes of Health Stroke Scale: A Pilot Study |
title_fullStr | Prehospital Identification of Large Vessel Occlusions Using Modified National Institutes of Health Stroke Scale: A Pilot Study |
title_full_unstemmed | Prehospital Identification of Large Vessel Occlusions Using Modified National Institutes of Health Stroke Scale: A Pilot Study |
title_short | Prehospital Identification of Large Vessel Occlusions Using Modified National Institutes of Health Stroke Scale: A Pilot Study |
title_sort | prehospital identification of large vessel occlusions using modified national institutes of health stroke scale: a pilot study |
topic | Neurology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8162654/ https://www.ncbi.nlm.nih.gov/pubmed/34054691 http://dx.doi.org/10.3389/fneur.2021.643356 |
work_keys_str_mv | AT mulkerinwilliamd prehospitalidentificationoflargevesselocclusionsusingmodifiednationalinstitutesofhealthstrokescaleapilotstudy AT spokoynyilanit prehospitalidentificationoflargevesselocclusionsusingmodifiednationalinstitutesofhealthstrokescaleapilotstudy AT franciscojonathant prehospitalidentificationoflargevesselocclusionsusingmodifiednationalinstitutesofhealthstrokescaleapilotstudy AT limabrandon prehospitalidentificationoflargevesselocclusionsusingmodifiednationalinstitutesofhealthstrokescaleapilotstudy AT corrymegand prehospitalidentificationoflargevesselocclusionsusingmodifiednationalinstitutesofhealthstrokescaleapilotstudy AT nudelmanmatthewjr prehospitalidentificationoflargevesselocclusionsusingmodifiednationalinstitutesofhealthstrokescaleapilotstudy AT niknamkian prehospitalidentificationoflargevesselocclusionsusingmodifiednationalinstitutesofhealthstrokescaleapilotstudy AT brownianp prehospitalidentificationoflargevesselocclusionsusingmodifiednationalinstitutesofhealthstrokescaleapilotstudy AT kohnmichaela prehospitalidentificationoflargevesselocclusionsusingmodifiednationalinstitutesofhealthstrokescaleapilotstudy AT govindarajanprasanthi prehospitalidentificationoflargevesselocclusionsusingmodifiednationalinstitutesofhealthstrokescaleapilotstudy |