ABSTRACT
There is no prehospital stratification tool specifically for predicting thrombolytic therapy after transportation. We developed a new prehospital scale named the Maria Prehospital Stroke Scale (MPSS) by modifying the Cincinnati Prehospital Stroke Scale. Our objective is to evaluate its utility in a citywide bypass transportation protocol for intravenous (IV) tissue plasminogen activator (tPA). In the MPSS, facial droop, arm drift, and speech disturbance are tested by emergency medical technicians (EMTs). Facial droop is graded as normal (0) or abnormal (1), and the other 2 items are graded in 3 levels as normal (0), not severe (1), and severe (2). Thus, the total MPSS score ranges from 0 to 5. The predictive value of MPSS for thrombolytic therapy after bypass transportation was evaluated in 1057 patients. The MPSS scored by EMTs was significantly correlated with the National Institutes of Health Stroke Scale score in the emergency room (Spearman rho = .67, P = .000). The onset-to-door time was significantly longer with a low MPSS score (analysis of variance, F5,4.21 = .001). The rate of thrombolytic therapy was increased when the MPSS score increased from 0 to 5: 0%, 4.1%, 8.8%, 13.0%, 20.3%, and 31.5%, respectively. The areas under the receiver operating characteristic curve for the correct diagnosis of stroke and prediction of IV tPA therapy were calculated as .737 (95% confidence interval [CI]: .688-.786) and .689 (95% CI: .645-.732), respectively. Multivariate logistic regression analysis showed that the MPSS score and the detection-to-door time were independent predictors of tPA use after transportation. The MPSS is a novel prehospital stratification tool for the prediction of thrombolytic therapy after transportation.
Subject(s)
Ambulances , Emergency Medical Services , Fibrinolytic Agents/administration & dosage , Health Status Indicators , Stroke/diagnosis , Stroke/drug therapy , Thrombolytic Therapy , Tissue Plasminogen Activator/administration & dosage , Administration, Intravenous , Adult , Aged , Aged, 80 and over , Area Under Curve , Chi-Square Distribution , Female , Humans , Japan , Logistic Models , Male , Middle Aged , Multivariate Analysis , Odds Ratio , Predictive Value of Tests , ROC Curve , Severity of Illness Index , Time Factors , Time-to-Treatment , Triage , Young AdultABSTRACT
We have performed rotational DSA for internal carotid artetry (ICA) stenosis and examined cross sectional imaging of the stenosis. Then, we compared the area stenosis rate (ASR) with stenosis rate by NASCET method and with results of duplex carotid ultrasonography. Of consecutive 451 patients who underwent digital subtraction angiography, 28 patients with ICA stenosis were selected for this study. Imaging data were transmitted to a workstation, and three-dimension (3-D) images were prepared, and cross sectional images of the highest-grade stenotic portion were obtained. ASRs were calculated [1-(the area of highest stenotic portion of ICA/the area of distal ICA)] x 100, which were compared with stenosis rates by NASCET method, as well as peak systolic velocity ratios (PSVR) of ICA to common carotid artery (CCA) determined by duplex carotid ultrasonography (USG). Cross sectional images in all patients were made except for restless patients, thereby morphology of the stenosis was feasible and measurements of cross section and diameter were possible. ASR and stenosis rate by NASCET method showed a very high correlation, and ASR was obtained by formula of (12.886 + 1.037 x stenosis rate by NASCET method). In patients with distorted stenosis, the stenosis rate was overestimated by NASECT method. ICA/CCA PSVR could predict stenosis to some extent, and in particular, all the patients with ICA/CCA PSVR of 3.1 or greater were found to have high grade stenosis. However duplex carotid USG failed to detect stenosis in a patient with high-grade stenosis at high position. In conclusion, as to ICA stenosis, 3-D image could show the stenosis precisely, and was considered to be useful as a routine examination.
