Abstract
Objective To identify a proximal anterior circulation occlusion for effectively administering immediate mechanical thrombectomy by developing a novel, simple diagnostic scale to predict the occlusion, to compare its validity with available scales, and to assess its utility.
Methods To develop a novel clinical scale, we retrospectively analyzed a cohort of 429 patients with acute ischemic stroke from a single center. The novel scale GAI2AA was applied to a prospective cohort of 259 patients from 3 stroke centers for external validation. The utility of the scale as an in-hospital triage was compared for the temporal factors of 158 patients with the occlusion.
Results In a scale-developmental phase, those with a proximal anterior circulation occlusion had significantly more frequent signs of hemispheric symptoms, including gaze palsy, aphasia, inattention, arm paresis, and atrial fibrillation. The GAI2AA scale was developed using consolidated hemispheric symptoms and was scored as follows: score = 2, arm paresis score = 1, and atrial fibrillation score = 1. A cutoff value ≥3 was optimal for the correlation between sensitivity (88%) and specificity (81%), with a C statistic of 0.90 (95% confidence interval 0.87–0.93). External validation indicated that discrimination was significantly better than or not different from that of available complex scales. Door-to-puncture time was significantly reduced (91 [82–111] vs 52 [32–75] minutes, p < 0.001).
Conclusion The GAI2AA scale showed high sensitivity and specificity when an optimal cutoff score was used and was useful as an in-hospital triage tool.
Glossary
- DAWN=
- DWI or CTP Assessment With Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention With Trevo;
- DEFUSE 3=
- Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke;
- GAI=
- gaze palsy, aphasia, or inattention;
- ICA=
- internal carotid artery;
- MRA=
- magnetic resonance angiography;
- NIHSS=
- NIH Stroke Scale;
- OR=
- odds ratio;
- PASS=
- Prehospital Acute Stroke Severity;
- ROC=
- receiver operating characteristic;
- 3I-SS=
- 3-Item Stroke Scale
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
The Article Processing Charge was funded by the authors.
Editorial, page 951
- Received February 25, 2019.
- Accepted in final form July 15, 2019.
- Copyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.
This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
Disputes & Debates: Rapid online correspondence
- Author response: Optimizing in-hospital triage for large vessel occlusion using a novel clinical scale (GAI2AA)
- Reader response: Optimizing in-hospital triage for large vessel occlusion using a novel clinical scale (GAI2AA)
- Author response: Optimizing in-hospital triage for large vessel occlusion using a novel clinical scale (GAI2AA)
- Reader response: Optimizing in-hospital triage for large vessel occlusion using a novel clinical scale (GAI2AA)
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