Prehospital scale to differentiate intracerebral hemorrhage from large-vessel occlusion patients: a prospective cohort study
Abstract Evaluating scales to detect large vessel occlusion (LVO) could aid in considering early referrals to a thrombectomy-capable center in the prehospital stroke code setting. Nevertheless, they entail a significant number of false positives, corresponding to intracranial hemorrhages (ICH). Our...
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2025-01-01
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| author | A. Freixa-Cruz G. Jimenez-Jimenez G. Mauri-Capdevila Y. Gallego-Sánchez A. García-Díaz R. Mitjana-Penella M. Paul-Arias C. Pereira-Priego E. Ruiz-Fernández S. Salvany-Montserrat A. Sancho-Saldaña E. San-Pedro-Murillo E. Saureu D. Vázquez-Justes Francisco Purroy |
| author_facet | A. Freixa-Cruz G. Jimenez-Jimenez G. Mauri-Capdevila Y. Gallego-Sánchez A. García-Díaz R. Mitjana-Penella M. Paul-Arias C. Pereira-Priego E. Ruiz-Fernández S. Salvany-Montserrat A. Sancho-Saldaña E. San-Pedro-Murillo E. Saureu D. Vázquez-Justes Francisco Purroy |
| author_sort | A. Freixa-Cruz |
| collection | DOAJ |
| description | Abstract Evaluating scales to detect large vessel occlusion (LVO) could aid in considering early referrals to a thrombectomy-capable center in the prehospital stroke code setting. Nevertheless, they entail a significant number of false positives, corresponding to intracranial hemorrhages (ICH). Our study aims to identify easily collectible variables for the development of a scale to differentiate patients with ICH from LVO. We conducted a prospective cohort study of stroke code patients between May 2021 and January 2023. Patients were evaluated with CT/CT-Angiography at arrival. We compared clinical variables and vascular risk factors between ICH and LVO patients. Out of 989 stroke code patients, we included 190 (66.7%) LVO cases and 95 (33.3) ICH cases. In the multivariate analysis, headache (odds ratio [OR] 3.56; 1.50–8.43), GCS < 8 (OR 8.19; 3.17–21.13), SBP > 160mmHg (OR 6.43; 3.37–12.26) and male sex (OR 2.07; 1.13–3.80) were associated with ICH, while previous hypercholesterolemia (OR 0.35; 0.19–0.65) with LVO. The scale design was conducted, assigning a score to each significant variable based on its specific weight: +2 points for SBP > 160, + 1 points for headache, + 1 points for male sex, + 2 points for GCS < 8, and − 1 points for HCL. The area under the curve was 0.82 (0.77–0.87). A score ≥ 4 exhibited a sensitivity of 0.10, a specificity of 0.99, a positive predictive value of 0.21, and a negative predictive value of 0.98. We present the development of a prehospital scale to discriminate between ICH and LVO patients, utilizing easily detectable variables in the prehospital setting. |
| format | Article |
| id | doaj-art-dd0f68c5d69545738e12e1d27c069a30 |
| institution | Kabale University |
| issn | 2045-2322 |
| language | English |
| publishDate | 2025-01-01 |
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| spelling | doaj-art-dd0f68c5d69545738e12e1d27c069a302025-01-26T12:31:10ZengNature PortfolioScientific Reports2045-23222025-01-0115111010.1038/s41598-025-86116-6Prehospital scale to differentiate intracerebral hemorrhage from large-vessel occlusion patients: a prospective cohort studyA. Freixa-Cruz0G. Jimenez-Jimenez1G. Mauri-Capdevila2Y. Gallego-Sánchez3A. García-Díaz4R. Mitjana-Penella5M. Paul-Arias6C. Pereira-Priego7E. Ruiz-Fernández8S. Salvany-Montserrat9A. Sancho-Saldaña10E. San-Pedro-Murillo11E. Saureu12D. Vázquez-Justes13Francisco Purroy14Stroke Unit, Department of Neurology, Universitat de Lleida, IRBLleida, Hospital Universitari Arnau de Vilanova de LleidaCritical Care Department, Hospital Universitari Arnau de Vilanova de LleidaStroke Unit, Department of Neurology, Universitat de Lleida, IRBLleida, Hospital Universitari Arnau de Vilanova de LleidaStroke Unit, Department of Neurology, Universitat de Lleida, IRBLleida, Hospital Universitari Arnau de Vilanova de LleidaStroke Unit, Department of Neurology, Universitat de Lleida, IRBLleida, Hospital Universitari Arnau de Vilanova de LleidaClinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de LleidaStroke Unit, Department of Neurology, Universitat de Lleida, IRBLleida, Hospital Universitari Arnau de Vilanova de LleidaClinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de LleidaStroke Unit, Department of Neurology, Universitat de Lleida, IRBLleida, Hospital Universitari Arnau de Vilanova de LleidaClinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de LleidaStroke Unit, Department of Neurology, Universitat de Lleida, IRBLleida, Hospital Universitari Arnau de Vilanova de LleidaStroke Unit, Department of Neurology, Universitat de Lleida, IRBLleida, Hospital Universitari Arnau de Vilanova de LleidaClinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de LleidaStroke Unit, Department of Neurology, Universitat de Lleida, IRBLleida, Hospital Universitari Arnau de Vilanova de LleidaStroke Unit, Department of Neurology, Universitat de Lleida, IRBLleida, Hospital Universitari Arnau de Vilanova de LleidaAbstract Evaluating scales to detect large vessel occlusion (LVO) could aid in considering early referrals to a thrombectomy-capable center in the prehospital stroke code setting. Nevertheless, they entail a significant number of false positives, corresponding to intracranial hemorrhages (ICH). Our study aims to identify easily collectible variables for the development of a scale to differentiate patients with ICH from LVO. We conducted a prospective cohort study of stroke code patients between May 2021 and January 2023. Patients were evaluated with CT/CT-Angiography at arrival. We compared clinical variables and vascular risk factors between ICH and LVO patients. Out of 989 stroke code patients, we included 190 (66.7%) LVO cases and 95 (33.3) ICH cases. In the multivariate analysis, headache (odds ratio [OR] 3.56; 1.50–8.43), GCS < 8 (OR 8.19; 3.17–21.13), SBP > 160mmHg (OR 6.43; 3.37–12.26) and male sex (OR 2.07; 1.13–3.80) were associated with ICH, while previous hypercholesterolemia (OR 0.35; 0.19–0.65) with LVO. The scale design was conducted, assigning a score to each significant variable based on its specific weight: +2 points for SBP > 160, + 1 points for headache, + 1 points for male sex, + 2 points for GCS < 8, and − 1 points for HCL. The area under the curve was 0.82 (0.77–0.87). A score ≥ 4 exhibited a sensitivity of 0.10, a specificity of 0.99, a positive predictive value of 0.21, and a negative predictive value of 0.98. We present the development of a prehospital scale to discriminate between ICH and LVO patients, utilizing easily detectable variables in the prehospital setting.https://doi.org/10.1038/s41598-025-86116-6Intracerebral hemorrhageHemorrhagic strokeIschemic strokeLarge vessel occlusionPrehospital ScaleStroke code |
| spellingShingle | A. Freixa-Cruz G. Jimenez-Jimenez G. Mauri-Capdevila Y. Gallego-Sánchez A. García-Díaz R. Mitjana-Penella M. Paul-Arias C. Pereira-Priego E. Ruiz-Fernández S. Salvany-Montserrat A. Sancho-Saldaña E. San-Pedro-Murillo E. Saureu D. Vázquez-Justes Francisco Purroy Prehospital scale to differentiate intracerebral hemorrhage from large-vessel occlusion patients: a prospective cohort study Scientific Reports Intracerebral hemorrhage Hemorrhagic stroke Ischemic stroke Large vessel occlusion Prehospital Scale Stroke code |
| title | Prehospital scale to differentiate intracerebral hemorrhage from large-vessel occlusion patients: a prospective cohort study |
| title_full | Prehospital scale to differentiate intracerebral hemorrhage from large-vessel occlusion patients: a prospective cohort study |
| title_fullStr | Prehospital scale to differentiate intracerebral hemorrhage from large-vessel occlusion patients: a prospective cohort study |
| title_full_unstemmed | Prehospital scale to differentiate intracerebral hemorrhage from large-vessel occlusion patients: a prospective cohort study |
| title_short | Prehospital scale to differentiate intracerebral hemorrhage from large-vessel occlusion patients: a prospective cohort study |
| title_sort | prehospital scale to differentiate intracerebral hemorrhage from large vessel occlusion patients a prospective cohort study |
| topic | Intracerebral hemorrhage Hemorrhagic stroke Ischemic stroke Large vessel occlusion Prehospital Scale Stroke code |
| url | https://doi.org/10.1038/s41598-025-86116-6 |
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