Paramedic identification of stroke: Community validation of the Melbourne Ambulance Stroke Screen

被引:104
作者
Bray, JE
Martin, J
Cooper, G
Barger, B
Bernard, S
Bladin, C
机构
[1] Eastern Melbourne Neurosci, Melbourne, Vic, Australia
[2] Univ Melbourne, Melbourne, Vic, Australia
[3] Metropolitan Ambulance Serv, Melbourne, Vic, Australia
[4] Deakin Univ, Melbourne, Vic, Australia
[5] Monash Univ, Melbourne, Vic 3004, Australia
关键词
ambulance; stroke diagnosis; emergency medical services; stroke assessment tool; management of acute stroke;
D O I
10.1159/000086201
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background: Paramedics require an effective prehospital tool to eliminate stroke mimics and to assist in the identification of suitable candidates for thrombolytic therapy. The Faster Access to Stroke Therapies study combined two validated stroke assessment tools (the Los Angeles Prehospital Stroke Screen, LAPSS, and the Cincinnati Prehospital Stroke Scale, CPSS) to form the Melbourne Ambulance Stroke Screen (MASS), and performed an in-field validation by Australian paramedics. Methods: Over a 12-month period, 18 paramedics participated in the Faster Access to Stroke Therapies study and prospectively collected data contained in the MASS on all stroke dispatches, and for other patients with a focal neurological deficit. Sensitivity and specificity analysis of the LAPSS, CPSS and MASS was calculated and equivalence analysis performed. Results: Paramedics completed 100 MASS assessments for 73 (73%) stroke/transient ischemic attack patients and 27 (27%) stroke mimics. The sensitivity of the MASS (90%, 95% CI: 81-96%) showed statistical equivalence to the sensitivity the CPSS (95%, p = 0.45) and superiority to the LAPSS (78%, p = 0.008). The specificity of the MASS (74%, 95% CI: 53-88%) was equivalent to that of the LAPSS (85%, p = 0.25) and superior to the CPSS (54%, p = 0.007). All patients misidentified by the MASS (7 strokes, 7 mimics) were ineligible for thrombolytic therapy. Conclusion: The MASS is simple to use, with accurate prehospital identification of stroke. It distinguishes stroke mimics, with good recognition of suitable patients for thrombolytic therapy. Copyright (C) 2005 S. Karger AG, Basel.
引用
收藏
页码:28 / 33
页数:6
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