Design and validation of a clinical scale for prehospital stroke recognition, severity grading and prediction of large vessel occlusion: the shortened NIH Stroke Scale for emergency medical services
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Key Points
To create a streamlined scale for rapid prehospital evaluation of stroke recognition, severity grading, and prediction of large vessel occlusion.
Developed the shortened NIH Stroke Scale for emergency medical services (sNIHSS-EMS) based on ratings from EMS personnel and stroke physicians (n=326).
Evaluated stroke recognition in 689 patients and large vessel occlusion prediction in 741 patients with ischemic stroke using acute vessel imaging.
Calculated sensitivity and specificity for stroke recognition and LVO prediction.
sNIHSS-EMS showed 91% sensitivity for stroke recognition (95% CI 86 to 94) and 52% specificity (95% CI 47 to 56).
For LVO prediction, a cutoff of ≥6 achieved 70% sensitivity (95% CI 65 to 76) and 81% specificity (95% CI 76 to 84).
The performance of the sNIHSS-EMS was non-inferior to existing, less comprehensive scales.
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Implication
Randomized trial develops a comprehensive stroke scale for emergency medical services, highlighting its effectiveness in prehospital assessment.