Usefulness of a single-parameter tool for the prediction of large vessel occlusion in acute stroke
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ORIGINAL COMMUNICATION
Usefulness of a single‑parameter tool for the prediction of large vessel occlusion in acute stroke Franck Leibinger1 · Thibaut Allou2 · Laurène Van Damme2 · Chawki Jebali3 · Caroline Arquizan4 · Geoffroy Farouil5 · Alexandre Laverdure3 · Nicolas Gaillard2,4 · Majo Ibanez2 · Philippe Smadja5 · Anais Dutray2 · Maxime Tardieu5 · Ludovic Nguyen Them2 · Ali Ousji3 · Snejana Jurici2 · Gregory Gascou6 · Zoubir Mourad Bensalah5 · Nadège Olivier2 · Frederique Damon2,3 · Wael Chaabane3 · Bénédicte Fadat2 · Marlène Lachcar3 · Julie Mas2 · Isabelle Mourand4 · Adelaïde Ferraro2 · Didier Heve7 · Adrian Dumitrana2 · Jean‑Christophe Blenet3 · Sabine Aptel5 · Vincent Costalat6 · Alain Bonafe5,6 · Laurent Ortega3 · Denis Sablot2,7 Received: 16 July 2020 / Revised: 14 October 2020 / Accepted: 20 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background In acute stroke, large vessel occlusion (LVO) should be promptly identified to guide patient’s transportation directly to comprehensive stroke centers (CSC) for mechanical thrombectomy (MT). In many cases, prehospital multiparameter scores are used by trained emergency teams to identify patients with high probability of LVO. However, in several countries, the first aid organization without intervention of skilled staff precludes the on-site use of such scores. Here, we assessed the accuracy of LVO prediction using a single parameter (i.e. complete hemiplegia) obtained by bystander’s telephone-based witnessing. Patients and methods This observational, single-center study included consecutive patients who underwent intravenous thrombolysis at the primary stroke center and/or were directly transferred to a CSC for MT, from January 1, 2015 to March 1, 2020. We defined two groups: patients with initial hemiplegia (no movement in one arm and leg and facial palsy) and patients without initial hemiplegia, on the basis of a bystander’s witnessing. Results During the study time, 874 patients were included [mean age 73 years (SD 13.8), 56.7% men], 320 with initial hemiplegia and 554 without. The specificity of the hemiplegia criterion to predict LVO was 0.88, but its sensitivity was only 0.53. Conclusion Our results suggest that the presence of hemiplegia as witnessed by a bystander can predict LVO with high specificity. This single criterion could be used for decision-making about direct transfer to CSC for MT when the absence of emergency skilled staff precludes the patient’s on-site assessment, especially in regions distant from a CSC. Keywords Thrombectomy · Stroke unit · Stroke management · Pre-hospital triage
Introduction
Franck Leibinger and Denis Sablot have contributed equally. * Denis Sablot denis.sablot@ch‑perpignan.fr 1
Intensive Care Unit, Centre Hospitalier de Perpignan, Perpignan, France
2
Neurology Department, Centre Hospitalier de Perpignan, 20 avenue du Languedoc, BP 4052, 66046 Perpignan, France
3
Emergency Department, Centre Hospitalier de Perpignan, Perpignan, France
In acute stroke, large ves
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