Sensitivity and specificity of modified Los Angeles prehospital stroke green / 中华神经医学杂志

ABSTRACT

Objective To evaluate the sensitivity and specificity of modified Los Angeles prehospital stroke screen (MLAPSS) in the diagnosis of acute stroke. Methods Prehospital personnel and physicians in the Emergency Department of 3 hospitals were trained for appropriate use of MLAPSS. The sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios, and Youden's index of MLAPSS for diagnosis of acute stroke were evaluated in patients with ischemic stroke, transient ischemic attack and intracerebral hemorrhage. Results Of a total of 2016 patients, 531 met the screening criteria of MLAPSS, among whom 157 had a final diagnosis of acute symptomatic cerebrovascular disease, including 82 with ischemic stroke, 17 with transient ischemic attack and 58 with intracerebral hemorrhages. The sensitivity, specificity and Youden index of MLAPSS for acute stroke diagnosis were 89% (95%CI: 85, 95), 95% (95%CI: 93, 97) and 0.85 (95%CI: 0.76, 0.94), with positive and negative predicted values of 89% (95%CI: 82, 95) and 96% (95%CI: 90, 100), and positive and negative likelihood ratios of 18 and 0.11, respectively. In the 531 patients, the missed diagnosis rate was 10% and the misdiagnosis rate was 5%. The average time to complete MLAPSS screening was 4 mitt 17 s. Conclusions MLAPSS has a relatively high sensitivity in the diagnosis of acute stroke with reduced misdiagnosis rate and high levels of specificity and predictive value. With easy operation, MLAPSS allows efficient screening of patients with acute stroke.