What question did this study set out to answer?

The study evaluates whether the Expanded-CASPR scale enhances identification of ICH compared to existing methods.

May 8, 2026Open Access

Abstract Number: Esoc2026ys262 the Expanded-Caspr Scale to Identify Intracerebral Hemorrhage Patients in the Prehospital Setting: Derivation and Validation in the Fast-Mag Trial

Puntos clave

The study evaluates whether the Expanded-CASPR scale enhances identification of ICH compared to existing methods.
Secondary analysis of prehospital data from the NIH FAST-MAG trial involving non-intubated patients.
Prediction models utilized CASPR-B and CASPR-ACS scales, augmented with selected NIHSS elements.
Internal validation employed a 70/30 training-testing split with ten-fold cross validation.
Enhanced models showed improved prediction accuracy for identifying ICH versus ischemic stroke.
Exploratory XGBoost models provided insights into feature importance among selected NIHSS elements.

Resumen

Abstract Background and aims Distinguishing intracerebral hemorrhage from ischemic stroke in the prehospital setting would improve destination hospital and blood pressure strategy. The California Acute Stroke Subtype Prehospital (CASPR) Scales (CASPR-B and CASPR-ACS), leveraging information available to first responders, shows moderate performance. This study aimed to evaluate whether an Expanded-CASPR (E-CASPR) Scale, augmented with select NIH Stroke Scale (NIHSS) elements, would improve ICH identification. Methods In secondary analysis of data from the prehospital NIH FAST-MAG randomized clinical trial, we analyzed non-intubated patients with a final diagnosis of ischemic stroke or ICH. Prediction models included CASPR-B (n=998) and CASPR-ACS (n=102), enhanced using selection of 5 among 13 candidate NIHSS elements, via Akaike Information Criterion (AIC). Internal validation used a 70/30 training-testing split with ten-fold cross validation. Exploratory XGBoost models assessed feature importance. Results Abstract complete, submitted to ESOC 2026 Abstract submissions: ESOC2026A1569 Conflict of interest Alexander Fish nothing to disclose, Angshuman Saha nothing to disclose, Jeffrey Saver reports consulting fees for advising on rigorous and safe clinical trial design and conduct from Abbott, Aeromics, Bayer, Biogen, Boehringer Ingelheim, BrainQ, BrainsGate, CSL Behring, Medtronic USA, Roche, Stream Medical, Johnson & Johnson, MIVI Neuroscience and Occlutech and holds stock options from MindRhythm, Neuronics Medical, and Rapid Medical. Contracted hourly payments for advising on rigorous and safe clinical trial design and conduct.

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