TY - JOUR
T1 - Sex Differences in Prehospital Identification of Large Vessel Occlusion in Patients with Suspected Stroke
AU - Ali, Mariam
AU - Dekker, Luuk
AU - Daems, Jasper D.
AU - Ali, Mahsoem
AU - van Zwet, Erik W.
AU - Steyerberg, Ewout W.
AU - Duvekot, Martijne H. C.
AU - Nguyen, T. Truc My
AU - Moudrous, Walid
AU - van de Wijdeven, Ruben M.
AU - Visser, Marieke C.
AU - de Laat, Karlijn F.
AU - Kerkhoff, Henk
AU - van den Wijngaard, Ido R.
AU - Dippel, Diederik W. J.
AU - Roozenbeek, Bob
AU - Kruyt, Nyika D.
AU - Wermer, Marieke J. H.
AU - Aerden, Leo A. M.
AU - Alblas, Kees C. L.
AU - Bakker, Jeannette
AU - van Belle, Eduard
AU - Bevelander, Timo
AU - Bosch, Jan
AU - Buijck, Bianca
AU - Dofferhoff-Vermeulen, Tamara
AU - van Doormaal, Pieter Jan
AU - Dorresteijn, Kirsten R. I. S.
AU - Duijndam, Dion
AU - van Eijkelenburg, Roeland P. J.
AU - van Es, Adriaan C. G. M.
AU - Hensen, Jan-Hein
AU - Hoek, Amber
AU - Kloos, Loet M. H.
AU - Koster, Gaia T.
AU - Kuiper, Jan Willem
AU - de Leeuw, Arnoud M.
AU - Lingsma, Hester F.
AU - van der Lugt, Aad
AU - Lycklama À Nijeholt, Geert
AU - Maasland, Lisette
AU - van Moll, Bruno J. M.
AU - Mulder, Laus J. M. M.
AU - Noordam-Reijm, Anja
AU - Oskam, Erick
AU - Plaisier, Aarnout
AU - Rozeman, Anouk D.
AU - de Schryver, Els L. L. M.
AU - Venema, Esmee
AU - Wijnhoud, Annemarie D.
AU - Willeboer, Merel L.
AU - Woudenberg, Mirjam
AU - van der Zon, Mandy M. A.
AU - Zwets, Egon D.
AU - Zylicz, Stas A.
N1 - Publisher Copyright: © 2024 Wolters Kluwer Health. All rights reserved.
PY - 2024/3/1
Y1 - 2024/3/1
N2 - BACKGROUND: Differences in clinical presentation of acute ischemic stroke between men and women may affect prehospital identification of anterior circulation large vessel occlusion (aLVO). We assessed sex differences in diagnostic performance of 8 prehospital scales to detect aLVO. METHODS: We analyzed pooled individual patient data from 2 prospective cohort studies (LPSS [Leiden Prehospital Stroke Study] and PRESTO [Prehospital Triage of Patients With Suspected Stroke Study]) conducted in the Netherlands between 2018 and 2019, including consecutive patients ≥18 years suspected of acute stroke who presented within 6 hours after symptom onset. Ambulance paramedics assessed clinical items from 8 prehospital aLVO detection scales: Los Angeles Motor Scale, Rapid Arterial Occlusion Evaluation, Cincinnati Stroke Triage Assessment Tool, Cincinnati Prehospital Stroke Scale, Prehospital Acute Stroke Severity, gaze-face-arm-speech-time, Conveniently Grasped Field Assessment Stroke Triage, and Face-Arm-Speech-Time Plus Severe Arm or Leg Motor Deficit. We assessed the diagnostic performance of these scales for identifying aLVO at prespecified cut points for men and women. RESULTS: Of 2358 patients with suspected stroke (median age, 73 years; 47% women), 231 (10%) had aLVO (100/1114 [9%] women and 131/1244 [11%] men). The area under the curve of the scales ranged from 0.70 (95% CI, 0.65-0.75) to 0.77 (95% CI, 0.73-0.82) in women versus 0.69 (95% CI, 0.64-0.73) to 0.75 (95% CI, 0.71-0.79) in men. Positive predictive values ranged from 0.23 (95% CI, 0.20-0.27) to 0.29 (95% CI, 0.26-0.31) in women versus 0.29 (95% CI, 0.24-0.33) to 0.37 (95% CI, 0.32-0.43) in men. Negative predictive values were similar (0.95 [95% CI, 0.94-0.96] to 0.98 [95% CI, 0.97-0.98] in women versus 0.94 [95% CI, 0.93-0.95] to 0.96 [95% CI, 0.94-0.97] in men). Sensitivity of the scales was slightly higher in women than in men (0.53 [95% CI, 0.43-0.63] to 0.76 [95% CI, 0.68-0.84] versus 0.49 [95% CI, 0.40-0.57] to 0.63 [95% CI, 0.55-0.73]), whereas specificity was lower (0.79 [95% CI, 0.76-0.81] to 0.87 [95% CI, 0.84-0.89] versus 0.82 [95% CI, 0.79-0.84] to 0.90 [95% CI, 0.88-0.91]). Rapid arterial occlusion evaluation showed the highest positive predictive values in both sexes (0.29 in women and 0.37 in men), reflecting the different event rates. CONCLUSIONS: aLVO scales show similar diagnostic performance in both sexes. The rapid arterial occlusion evaluation scale may help optimize prehospital transport decision-making in men as well as in women with suspected stroke.
AB - BACKGROUND: Differences in clinical presentation of acute ischemic stroke between men and women may affect prehospital identification of anterior circulation large vessel occlusion (aLVO). We assessed sex differences in diagnostic performance of 8 prehospital scales to detect aLVO. METHODS: We analyzed pooled individual patient data from 2 prospective cohort studies (LPSS [Leiden Prehospital Stroke Study] and PRESTO [Prehospital Triage of Patients With Suspected Stroke Study]) conducted in the Netherlands between 2018 and 2019, including consecutive patients ≥18 years suspected of acute stroke who presented within 6 hours after symptom onset. Ambulance paramedics assessed clinical items from 8 prehospital aLVO detection scales: Los Angeles Motor Scale, Rapid Arterial Occlusion Evaluation, Cincinnati Stroke Triage Assessment Tool, Cincinnati Prehospital Stroke Scale, Prehospital Acute Stroke Severity, gaze-face-arm-speech-time, Conveniently Grasped Field Assessment Stroke Triage, and Face-Arm-Speech-Time Plus Severe Arm or Leg Motor Deficit. We assessed the diagnostic performance of these scales for identifying aLVO at prespecified cut points for men and women. RESULTS: Of 2358 patients with suspected stroke (median age, 73 years; 47% women), 231 (10%) had aLVO (100/1114 [9%] women and 131/1244 [11%] men). The area under the curve of the scales ranged from 0.70 (95% CI, 0.65-0.75) to 0.77 (95% CI, 0.73-0.82) in women versus 0.69 (95% CI, 0.64-0.73) to 0.75 (95% CI, 0.71-0.79) in men. Positive predictive values ranged from 0.23 (95% CI, 0.20-0.27) to 0.29 (95% CI, 0.26-0.31) in women versus 0.29 (95% CI, 0.24-0.33) to 0.37 (95% CI, 0.32-0.43) in men. Negative predictive values were similar (0.95 [95% CI, 0.94-0.96] to 0.98 [95% CI, 0.97-0.98] in women versus 0.94 [95% CI, 0.93-0.95] to 0.96 [95% CI, 0.94-0.97] in men). Sensitivity of the scales was slightly higher in women than in men (0.53 [95% CI, 0.43-0.63] to 0.76 [95% CI, 0.68-0.84] versus 0.49 [95% CI, 0.40-0.57] to 0.63 [95% CI, 0.55-0.73]), whereas specificity was lower (0.79 [95% CI, 0.76-0.81] to 0.87 [95% CI, 0.84-0.89] versus 0.82 [95% CI, 0.79-0.84] to 0.90 [95% CI, 0.88-0.91]). Rapid arterial occlusion evaluation showed the highest positive predictive values in both sexes (0.29 in women and 0.37 in men), reflecting the different event rates. CONCLUSIONS: aLVO scales show similar diagnostic performance in both sexes. The rapid arterial occlusion evaluation scale may help optimize prehospital transport decision-making in men as well as in women with suspected stroke.
KW - acute ischemic stroke
KW - emergency medical services
KW - large vessel occlusion
KW - sex
KW - thrombectomy
UR - http://www.scopus.com/inward/record.url?scp=85186220746&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.123.044898
DO - 10.1161/STROKEAHA.123.044898
M3 - Article
C2 - 38299328
SN - 0039-2499
VL - 55
SP - 548
EP - 554
JO - Stroke
JF - Stroke
IS - 3
ER -