Improved performance of new prenotification criteria for acute stroke patients

Ming Ju Hsieh, Sung Chun Tang, Patrick Chow In Ko, Wen Chu Chiang, Li Kai Tsai, Anna Marie Chang, An Yi Wang, Shin Joe Yeh, Kuang Yu Huang, Jiann Shing Jeng, Matthew Huei Ming Ma

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background/purpose: We aim to evaluate the accuracy of the new prehospital notification criteria for patients with potential acute stroke in the prehospital setting. Methods: We conducted a retrospective observational study from March 2011 to February 2013 of potential acute stroke patients prenotified using the new criteria which were: (1) positive Cincinnati Prehospital Stroke Scale (CPSS); (2) symptom onset within 3 hours; and (3) blood glucose level > 60 mg/dL. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the new criteria were calculated and outcomes of acute stroke patients were reported. Data of all patients with stroke or transient ischemic attack (TIA) transported to the destination hospital were also obtained to evaluate the compliance of emergency medical technicians. Results: There were 2888 patients suspected of stroke by emergency medical technicians and 221 patients prenotified due to meeting the criteria. The PPV, NPV, sensitivity, and specificity of the new criteria were 76.9%, 96.6%, 64.9%, and 98.1%, respectively. Onset time > 3 hours (24/51, 47.1%) and seizure (27.5%) were the two most common conditions leading to false prenotification. Of all prenotified patients, 23.1% (51/221) received thrombolytic therapy. Hemorrhagic stroke or ischemic stroke with hemorrhagic transformation (53.8%) and minor symptoms or rapid recovery (26.9%) were the most common reasons excluding correctly prenotified patients from thrombolytic therapy. Conclusion: The accuracy of the new prehospital stroke criteria has higher PPV and specificity compared to previous CPSS validation studies.

Original languageEnglish
Pages (from-to)257-262
Number of pages6
JournalJournal of the Formosan Medical Association
Volume115
Issue number4
DOIs
Publication statusPublished - Apr 1 2016
Externally publishedYes

Fingerprint

Stroke
Emergency Medical Technicians
Thrombolytic Therapy
Sensitivity and Specificity
Validation Studies
Transient Ischemic Attack
Compliance
Observational Studies
Blood Glucose
Seizures
Retrospective Studies

Keywords

  • Emergency medical services
  • Prehospital stroke scale
  • Prenotification
  • Sensitivity and specificity
  • Stroke care

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Hsieh, M. J., Tang, S. C., Ko, P. C. I., Chiang, W. C., Tsai, L. K., Chang, A. M., ... Ma, M. H. M. (2016). Improved performance of new prenotification criteria for acute stroke patients. Journal of the Formosan Medical Association, 115(4), 257-262. https://doi.org/10.1016/j.jfma.2015.03.007

Improved performance of new prenotification criteria for acute stroke patients. / Hsieh, Ming Ju; Tang, Sung Chun; Ko, Patrick Chow In; Chiang, Wen Chu; Tsai, Li Kai; Chang, Anna Marie; Wang, An Yi; Yeh, Shin Joe; Huang, Kuang Yu; Jeng, Jiann Shing; Ma, Matthew Huei Ming.

In: Journal of the Formosan Medical Association, Vol. 115, No. 4, 01.04.2016, p. 257-262.

Research output: Contribution to journalArticle

Hsieh, MJ, Tang, SC, Ko, PCI, Chiang, WC, Tsai, LK, Chang, AM, Wang, AY, Yeh, SJ, Huang, KY, Jeng, JS & Ma, MHM 2016, 'Improved performance of new prenotification criteria for acute stroke patients', Journal of the Formosan Medical Association, vol. 115, no. 4, pp. 257-262. https://doi.org/10.1016/j.jfma.2015.03.007
Hsieh, Ming Ju ; Tang, Sung Chun ; Ko, Patrick Chow In ; Chiang, Wen Chu ; Tsai, Li Kai ; Chang, Anna Marie ; Wang, An Yi ; Yeh, Shin Joe ; Huang, Kuang Yu ; Jeng, Jiann Shing ; Ma, Matthew Huei Ming. / Improved performance of new prenotification criteria for acute stroke patients. In: Journal of the Formosan Medical Association. 2016 ; Vol. 115, No. 4. pp. 257-262.
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abstract = "Background/purpose: We aim to evaluate the accuracy of the new prehospital notification criteria for patients with potential acute stroke in the prehospital setting. Methods: We conducted a retrospective observational study from March 2011 to February 2013 of potential acute stroke patients prenotified using the new criteria which were: (1) positive Cincinnati Prehospital Stroke Scale (CPSS); (2) symptom onset within 3 hours; and (3) blood glucose level > 60 mg/dL. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the new criteria were calculated and outcomes of acute stroke patients were reported. Data of all patients with stroke or transient ischemic attack (TIA) transported to the destination hospital were also obtained to evaluate the compliance of emergency medical technicians. Results: There were 2888 patients suspected of stroke by emergency medical technicians and 221 patients prenotified due to meeting the criteria. The PPV, NPV, sensitivity, and specificity of the new criteria were 76.9{\%}, 96.6{\%}, 64.9{\%}, and 98.1{\%}, respectively. Onset time > 3 hours (24/51, 47.1{\%}) and seizure (27.5{\%}) were the two most common conditions leading to false prenotification. Of all prenotified patients, 23.1{\%} (51/221) received thrombolytic therapy. Hemorrhagic stroke or ischemic stroke with hemorrhagic transformation (53.8{\%}) and minor symptoms or rapid recovery (26.9{\%}) were the most common reasons excluding correctly prenotified patients from thrombolytic therapy. Conclusion: The accuracy of the new prehospital stroke criteria has higher PPV and specificity compared to previous CPSS validation studies.",
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AU - Ko, Patrick Chow In

AU - Chiang, Wen Chu

AU - Tsai, Li Kai

AU - Chang, Anna Marie

AU - Wang, An Yi

AU - Yeh, Shin Joe

AU - Huang, Kuang Yu

AU - Jeng, Jiann Shing

AU - Ma, Matthew Huei Ming

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N2 - Background/purpose: We aim to evaluate the accuracy of the new prehospital notification criteria for patients with potential acute stroke in the prehospital setting. Methods: We conducted a retrospective observational study from March 2011 to February 2013 of potential acute stroke patients prenotified using the new criteria which were: (1) positive Cincinnati Prehospital Stroke Scale (CPSS); (2) symptom onset within 3 hours; and (3) blood glucose level > 60 mg/dL. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the new criteria were calculated and outcomes of acute stroke patients were reported. Data of all patients with stroke or transient ischemic attack (TIA) transported to the destination hospital were also obtained to evaluate the compliance of emergency medical technicians. Results: There were 2888 patients suspected of stroke by emergency medical technicians and 221 patients prenotified due to meeting the criteria. The PPV, NPV, sensitivity, and specificity of the new criteria were 76.9%, 96.6%, 64.9%, and 98.1%, respectively. Onset time > 3 hours (24/51, 47.1%) and seizure (27.5%) were the two most common conditions leading to false prenotification. Of all prenotified patients, 23.1% (51/221) received thrombolytic therapy. Hemorrhagic stroke or ischemic stroke with hemorrhagic transformation (53.8%) and minor symptoms or rapid recovery (26.9%) were the most common reasons excluding correctly prenotified patients from thrombolytic therapy. Conclusion: The accuracy of the new prehospital stroke criteria has higher PPV and specificity compared to previous CPSS validation studies.

AB - Background/purpose: We aim to evaluate the accuracy of the new prehospital notification criteria for patients with potential acute stroke in the prehospital setting. Methods: We conducted a retrospective observational study from March 2011 to February 2013 of potential acute stroke patients prenotified using the new criteria which were: (1) positive Cincinnati Prehospital Stroke Scale (CPSS); (2) symptom onset within 3 hours; and (3) blood glucose level > 60 mg/dL. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the new criteria were calculated and outcomes of acute stroke patients were reported. Data of all patients with stroke or transient ischemic attack (TIA) transported to the destination hospital were also obtained to evaluate the compliance of emergency medical technicians. Results: There were 2888 patients suspected of stroke by emergency medical technicians and 221 patients prenotified due to meeting the criteria. The PPV, NPV, sensitivity, and specificity of the new criteria were 76.9%, 96.6%, 64.9%, and 98.1%, respectively. Onset time > 3 hours (24/51, 47.1%) and seizure (27.5%) were the two most common conditions leading to false prenotification. Of all prenotified patients, 23.1% (51/221) received thrombolytic therapy. Hemorrhagic stroke or ischemic stroke with hemorrhagic transformation (53.8%) and minor symptoms or rapid recovery (26.9%) were the most common reasons excluding correctly prenotified patients from thrombolytic therapy. Conclusion: The accuracy of the new prehospital stroke criteria has higher PPV and specificity compared to previous CPSS validation studies.

KW - Emergency medical services

KW - Prehospital stroke scale

KW - Prenotification

KW - Sensitivity and specificity

KW - Stroke care

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