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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >A Clinical Paradigm for Classifying Neurologic Symptoms to Screen for Emergent Large Vessel Occlusions
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A Clinical Paradigm for Classifying Neurologic Symptoms to Screen for Emergent Large Vessel Occlusions

机译：用于分类神经系统症状的临床范式，以筛选出急的大血管闭塞

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Background: With newly-extended treatment windows for endovascular therapy in emergent large vessel occlusions, it is increasingly important to identify thrombectomy- eligible patients without overwhelming resources dedicated to acute stroke care. We devised a simple paradigm to classify patient's presenting neurologic symptoms to screen for large vessel occlusions. Methods: We reviewed the presenting symptoms, imaging findings, and final diagnoses of consecutive emergency department stroke alert cases. Patients were classified based on their neurologic exams as focal objective, focal subjective, or nonfocal. Outcomes of final diagnoses of acute ischemic stroke and large vessel occlusions were compared across groups. Comparisons were made to other large vessel occlusion prediction scales. Results: Of 521 patients, 342 (65.6%) were categorized as focal objective, 142 (27.2%) as focal subjective, and 37 (7.1%) as nonfocal. Ischemic stroke and large vessel occlusions were diagnosed in 114 (21.9%) and 27 (5.2%) of patients, respectively. Classification as focal objective significantly predicted stroke (odds ratio 3.77; 95% confidence interval 2.17-6.55) and captured all large vessel occlusions (P =.0001). The focal objective categorization was the only tool which achieved 100% sensitivity for large vessel occlusions (with a specificity of 36%) compared to other large vessel occlusion prediction tools. Conclusions: Patients who presented as stroke alerts without focal neurologic symptoms were unlikely to have large vessel occlusions. With high sensitivity, classifying patients' neurologic exams into focal objective versus subjective or nonfocal categories may serve as a useful tool to screen for large vessel occlusions and prevent unnecessary emergent workup in patients unlikely to be endovascular candidates.
机译：背景技术：随着新延长的治疗窗中的肠胃疗法，令人兴奋的大血管闭塞，鉴定血液切除术患者越来越重要，没有压倒性地致力于急性中风护理。我们设计了一个简单的范式来对患者的呈现神经系统症状进行分类到筛选大血管闭塞。方法：我们审查了连续急诊部中行程警报案件的呈现症状，成像结果和最终诊断。患者根据其神经检查，作为焦点目标，焦点主观或非焦点进行分类。在组中比较了急性缺血性卒中的最终诊断结果和大容器闭塞。对其他大血管闭塞预测尺度进行了比较。结果：521名患者，342名（65.6％）分类为局灶性目标，142（27.2％）为局灶性主观，37（7.1％）为非焦点。缺血性脑卒中和大容器闭塞分别诊断为114（21.9％）和27例（5.2％）患者。分类为焦点目标明显预测中风（差距3.77; 95％置信区间2.17-6.55）并捕获了所有大容器闭塞（P = .0001）。与其他大血管闭塞预测工具相比，焦点目标分类是唯一实现的大容器闭塞（特异性为36％）的唯一工具。结论：呈现为卒中警报的患者没有局灶性神经系统症状，不太可能具有大容器闭塞。敏感性高，将患者的神经检查分类为焦点目标与主观或非焦类类别可以作为筛选大容器闭塞的有用工具，并防止不太可能是血管内候选者的患者的不必要的紧急工作。

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