Accuracy of Published Screening Tools for Large Vessel Occlusion in Patients With Suspected Acute Ischemic Stroke: A Prospective Cohort Study - 18/12/25
Abstract |
Study objective |
To identify the most accurate screening tool for predicting a large vessel occlusion in patients with a suspected acute ischemic stroke.
Methods |
Between January 2022 and April 2023, adult patients with a suspected acute ischemic stroke for whom an emergency physician activated the stroke code (indicating potential eligibility for thrombolysis and/or thrombectomy) at the emergency department (ED) of l’Hôpital de l’Enfant-Jésus-CHU de Québec, a tertiary care center for neurologic diseases, were prospectively included. Demographic data and variables included in 8 screening tools were collected by the emergency physician prior to the head computed tomography using a standardized data collection form. The performance of each tool to identify patients with a large vessel occlusion was assessed using the accuracy with 95% confidence intervals (CIs) and the McNemar test was used to compare the performance of the tools.
Results |
A total of 390 patients were included in the study (mean age: 72.3 years; men: 48.2%). Acute ischemic strokes was the final diagnosis in 259 patients (66.4%) of which 111 (28.5%) had a large vessel occlusion. The accuracy of Field Assessment Stroke Triage for Emergency Destination (FAST-ED) was 0.76 (95% CI 0.72 to 0.81), which was not significantly different from that of Rapid Arterial Occlusion Evaluation Scale (0.75, 95% CI 0.71 to 0.80), Los Angeles Motor Scale (0.75, 95% CI 0.71 to 0.79), or Large ARtery Intracranial Occlusion stroke scale (0.72, 95% CI 0.68 to 0.77). However, it was significantly higher than the accuracy of Conveniently-Grasped FAST, Ambulance Clinical Triage-FAST, Vision, Aphasia, Neglect assessment, and Face-Arm-Speech-Time plus severe arm or leg motor deficit. Cincinnati Prehospital Stroke Scale, when performed by either the emergency physicians or paramedics, demonstrated poor accuracy, with values of 0.34 (95% CI 0.29 to 0.39) and 0.37 (95% CI 0.32 to 0.34), respectively.
Conclusion |
This study provides valuable insights into the accuracy of various large vessel occlusion screening tools for patients in our ED setting with FAST-ED, Rapid Arterial Occlusion Evaluation Scale, and Los Angeles Motor Scale showing the highest levels of accuracy. These findings will contribute to the development of evidence-based care pathways for improving stroke diagnosis and management.
Le texte complet de cet article est disponible en PDF.Keywords : Stroke, Thrombolysis, Endovascular intervention, Tools
Plan
| Please see page 16 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Allan B. Wolfson, MD. Specific detailed information about possible conflict of interest for individual editors is available at editors . |
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| Author contributions : FD and EM conceived the study, designed the trial, and obtained research funding. EM and AN supervised the conduct of the trial and data collection. AN undertook recruitment of participating centers and patients and managed the data, including quality control. PAT provided statistical advice on study design and analyzed the data. FD drafted the manuscript, and all authors contributed substantially to its revision. EM takes responsibility for the paper as a whole. |
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| Data sharing statement : The entire deidentified data set, data dictionary and analytic code for this investigation are available on request, from the date of article publication by contacting Eric Mercier, MD, MSc, at email eric.mercier@fmed.ulaval.ca . |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/ ). This study was funded by the Département de Médecine Familiale et de Médecine d’Urgence (DMFMU) de l’Université Laval and by l’Association des Spécialistes en Médecine d’Urgence du Québec (ASMUQ). The funders had no role in the study design, data collection, data analysis, or the writing of the report. |
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| Presentation information: American College of Emergency Physicians Scientific Assembly 2023, Philadelphia, October 9-12, 2023 and European Society for Emergency Medicine Congress 2023, Barcelona, September 16-20, 2023. |
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| A podcast for this article is available at www.annemergmed.com . |
Vol 87 - N° 1
P. 15-24 - janvier 2026 Retour au numéro
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