wileyonlinelibrary.com/journal/ane Acta Neurol Scand. 2018;138:24–31.
© 2018 John Wiley & Sons A/S.
Published by John Wiley & Sons Ltd
1 | INTRODUCTION
Previous randomized controlled trials showed that endovascular
therapy following systemic fibrinolysis reduces disability and death
in acute ischemic stroke patients with large vessel occlusion more
than the only pharmacological treatment and these results were
confirmed also in recent meta- analyses.
These findings influenced
the modification of International Guidelines with new recommenda-
tions concerning the acute treatment in selected patients.
stroke is a time- dependent disease, the impact of these treatments is
highly dependent on rapid identification of severe symptoms by the
Emergency Medical Service personnel and on a prompt transport to
a comprehensive stroke center. However, these last Units are lim-
ited for availability of bed numbers and resources. The concomitant
time sensitivity for both treatments (endovascular and systemic) in-
fluences the choice of the reference hospital. The accurate selection
and identification of patients with high probability of a large vessel
occlusion in the prehospital phase could be of fundamental impor-
tance to rationalize the transport of correct strokes in the more suit-
able center. For these reasons, several clinical examination tools have
been designed and applied in the prehospital setting with different
Accepted: 17 January 2018
Prehospital stroke scales and large vessel occlusion: A
| E. Agostoni
Department of Neurology & Stroke
Unit, Sant’Anna Hospital, Como, Italy
Department of Neurology & Stroke
Unit, Niguarda Ca’ Granda Hospital, Milan,
S. Vidale, Department of Neurology & Stroke
Unit, Sant’Anna Hospital, Como, Italy.
Background and purpose: Time sensitivity for pharmacological and mechanical arterial
recanalization in acute ischemic stroke influences the choice of the reference hospital.
The accurate selection and identification of patients with high probability of a large
vessel occlusion (LVO) in the prehospital setting improve the rationalization of the
transport in the more suitable centers. Aim of this analysis was to determine the diag-
nostic accuracy of prehospital stroke scales detecting LVO.
Material and methods: Studies were searched into MEDLINE, EMBASE, and CINHAL
databases between January 1990 and September 2017. Principal measurements of
the meta- analysis were the overall accuracy level, sensitivity, and specificity of pre-
hospital stroke scales.
Results: Nineteen scoring systems were included in the analysis coming from 13 stud-
ies. A total of 9824 patients were considered. Although a higher heterogeneity was
observed in the analysis, three scores showed better results in predicting a LVO (the
stroke Vision, Aphasia, Neglect assessment, the National Institute of Health Stroke
scale and the Los Angeles Motor Scale). We observed significant differences of overall
accuracy only for scores including hemineglect as cortical neurological sign (P < .05).
Conclusions: This meta- analysis suggests that some prehospital scoring systems in-
cluding cortical signs showed better accuracy to predict stroke due to LVO. However,
the assessment of these signs could be difficult to investigate by paramedics and per-
sonnel of Emergency Medical Services, and for this reason, further prospective evalu-
ations are needed.
large vessel occlusion, meta-analysis, prehospital stroke scale, thrombolysis