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De Luca A, Mariani M, Riccardi MT, Damiani G. The role of the Cincinnati Prehospital Stroke Scale in the emergency department: evidence from a systematic review and meta-analysis. Open Access Emerg Med 2019; 11:147-159. [PMID: 31410071 PMCID: PMC6646799 DOI: 10.2147/oaem.s178544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 06/21/2019] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Stroke is one of the leading causes of morbidity, disability, and mortality in high-income countries. Early prehospital stroke recognition plays a fundamental role, because most clinical decisions should be made within the first hours after onset of symptoms. The Cincinnati Prehospital Stroke Scale (CPSS) is a validated screening tool whose utilization is suggested during triage. The aim of this study is to review the role of the CPSS by assessing its sensitivity and specificity in prehospital and hospital settings. METHODS A systematic review and a meta-analysis of the literature reporting the CPSS sensitivity and specificity among patients suspected of stroke were undertaken. Electronic databases were searched up to December 2018, and the quality assessment was carried out by using the Revised Quality Assessment of Diagnostic Accuracy Studies -2 (QUADAS-2). RESULTS Eleven studies were included in the meta-analysis. Results showed an overall sensitivity of 82.46% (95% confidence interval [CI] 74.83-88.09%) and specificity of 56.95% (95% CI 41.78-70.92). No significant differences were found in terms of sensitivity when CPSS was performed by physicians (80.11%, 95% CI 66.14-89.25%) or non-physicians (81.11%, 95% CI 69.78-88.87%). However, administration by physicians resulted in higher specificity (73.57%, 95% CI 65.78-80.12%) when compared to administration by non-physicians (50.07%, 95% CI 31.54-68.58%). Prospective studies showed higher specificity 71.61% (95% CI 61.12-80.18%) and sensitivity 86.82% (95% CI 74.72-93.63) when compared to retrospective studies which showed specificity of 33.37% (95% CI 22.79-45.94%) and sensitivity of 78.52% (95% CI 75.08-81.60). CONCLUSIONS The CPSS is a standardized and easy-to-use stroke screening tool whose implementation in emergency systems protocols, along with proper and consistent coordination with local, regional, and state agencies, medical authorities and local experts are suggested.
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Affiliation(s)
- A De Luca
- Istituti Fisioterapici Ospitalieri, Rome, Italy
| | - M Mariani
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - MT Riccardi
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Damiani
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
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Sadeghi-Hokmabadi E, Farhoudi M, Taheraghdam A, Hashemilar M, Savadi-Osguei D, Rikhtegar R, Mehrvar K, Sharifipour E, Youhanaee P, Mirnour R. Intravenous recombinant tissue plasminogen activator for acute ischemic stroke: a feasibility and safety study. Int J Gen Med 2016; 9:361-367. [PMID: 27822079 PMCID: PMC5087792 DOI: 10.2147/ijgm.s112430] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background In developing countries, intravenous thrombolysis (IVT) is available at a limited number of centers. This study aimed to assess the feasibility and safety of IVT at Tabriz Imam Reza Hospital. Methods In a prospective study, over a 55-month period, any patient at the hospital for whom stroke code had been activated was enrolled in the study. Data on demographic characteristics, stroke risk factors, admission blood pressure, blood tests, findings of brain computed tomography (CT) scans, time of symtom onset, time of arrival to the emergency department, time of stroke code activation, time of CT scan examination, and the time of recombinant tissue plasminogen activator administration were recorded. National Institutes of Health Stroke Scale assessments were performed before IVT bolus, at 36 hours, at either 7 days or discharge (which ever one was earlier), and at 3-month follow-up. Brain CT scans were done for all patients before and 24 hours after the treatment. Results Stroke code was activated for 407 patients and IVT was done in 168 patients. The rate of functional independence (modified Rankin Scale [mRS] 0–1) at 3 months was 39.2% (62/158). The mortality rate at day 7 was 6% (10/168). Hemorrhagic transformation was noted in 16 patients (9.5%). Symptomatic intracranial hemorrhage occurred in 5 (3%), all of which were fatal. One case of severe urinary bleeding and one other fatal case of severe angioedema were observed. Conclusion During the first 4–5 years of administration of IVT in the hospital, it was found to be feasible and safe, but to increase the efficacy, poststroke care should be more organized and a stroke center should be established.
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Affiliation(s)
- Elyar Sadeghi-Hokmabadi
- Neurosciences Research Center, Neurology Department, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran
| | - Mehdi Farhoudi
- Neurosciences Research Center, Neurology Department, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran
| | - Aliakbar Taheraghdam
- Neurosciences Research Center, Neurology Department, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran
| | - Mazyar Hashemilar
- Neurosciences Research Center, Neurology Department, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran
| | - Daryous Savadi-Osguei
- Neurosciences Research Center, Neurology Department, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran
| | - Reza Rikhtegar
- Neurosciences Research Center, Neurology Department, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran
| | - Kaveh Mehrvar
- Neurosciences Research Center, Neurology Department, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran
| | - Ehsan Sharifipour
- Neurosciences Research Center, Neurology Department, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran
| | - Parisa Youhanaee
- Neurosciences Research Center, Neurology Department, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran
| | - Reshad Mirnour
- Neurosciences Research Center, Neurology Department, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran
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Simple In-Hospital Interventions to Reduce Door-to-CT Time in Acute Stroke. Int J Vasc Med 2016; 2016:1656212. [PMID: 27478641 PMCID: PMC4958441 DOI: 10.1155/2016/1656212] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 06/12/2016] [Indexed: 12/11/2022] Open
Abstract
Background. Intravenous tissue plasminogen activator, a time dependent therapy, can reduce the morbidity and mortality of acute ischemic stroke. This study was designed to assess the effect of simple in-hospital interventions on reducing door-to-CT (DTC) time and reaching door-to-needle (DTN) time of less than 60 minutes. Methods. Before any intervention, DTC time was recorded for 213 patients over a one-year period at our center. Five simple quality-improvement interventions were implemented, namely, call notification, prioritizing patients for CT scan, prioritizing patients for lab analysis, specifying a bed for acute stroke patients, and staff education. After intervention, over a course of 44 months, DTC time was recorded for 276 patients with the stroke code. Furthermore DTN time was recorded for 106 patients who were treated with IV thrombolytic therapy. Results. The median DTC time significantly decreased in the postintervention period comparing to the preintervention period [median (IQR); 20 (12-30) versus 75 (52.5-105), P < 0.001]. At the postintervention period, the median (IQR) DTN time was 55 (40-73) minutes and proportion of patients with DTN time less than 60 minutes was 62.4% (P < 0.001). Conclusion. Our interventions significantly reduced DTC time and resulted in an acceptable DTN time. These interventions are feasible in most hospitals and should be considered.
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Kara H, Degirmenci S, Bayir A, Ak A, Akinci M, Dogru A, Akyurek F, Kayis SA. Red cell distribution width and neurological scoring systems in acute stroke patients. Neuropsychiatr Dis Treat 2015; 11:733-9. [PMID: 25834448 PMCID: PMC4370912 DOI: 10.2147/ndt.s81525] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES The purpose of the present study was to evaluate the association between the red blood cell distribution width (RDW) and the Glasgow Coma Scale (GCS), Canadian Neurological Scale (CNS), and National Institutes of Health Stroke Scale (NIHSS) scores in patients who had acute ischemic stroke. METHODS This prospective observational cohort study included 88 patients who have had acute ischemic stroke and a control group of 40 patients who were evaluated in the Emergency Department for disorders other than acute ischemic stroke. All subjects had RDW determined, and stroke patients had scoring with the GCS, CNS, and NIHSS scores. The GCS, CNS, and NIHSS scores of the patients were rated as mild, moderate, or severe and compared with RDW. RESULTS Stroke patients had significantly higher median RDW than control subjects. The median RDW values were significantly elevated in patients who had more severe rather than milder strokes rated with all three scoring systems (GCS, CNS, and NIHSS). The median RDW values were significantly elevated for patients who had moderate rather than mild strokes rated by GCS and CNS and for patients who had severe rather than mild strokes rated by NIHSS. The area under the receiver operating characteristic curve was 0.760 (95% confidence interval, 0.676-0.844). Separation of stroke patients and control groups was optimal with RDW 14% (sensitivity, 71.6%; specificity, 67.5%; accuracy, 70.3%). CONCLUSION In stroke patients who have symptoms <24 hours, the RDW may be useful in predicting the severity and functional outcomes of the stroke.
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Affiliation(s)
- Hasan Kara
- Department of Emergency Medicine, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Selim Degirmenci
- Department of Emergency Medicine, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Aysegul Bayir
- Department of Emergency Medicine, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Ahmet Ak
- Department of Emergency Medicine, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Murat Akinci
- Department of Emergency Medicine, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Ali Dogru
- Department of Emergency Medicine, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Fikret Akyurek
- Department of Biochemistry, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Seyit Ali Kayis
- Department of Biostatistics, Faculty of Medicine, Karabuk University, Karabuk, Turkey
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