Régulation téléphonique des AVC : outil d’aide au triage des occlusions des gros troncs supra aortiques (Alpha Stroke Score)

Abstract : BACKGROUND. Thrombectomy has been shown to be effective in the treatment of ischemic stroke due to large vessel occlusion (LVO) but requires a platform not available in all hospitals. The diagnosis of LVO is made only through brain and vessel imaging. We have tried to find predictive factors of LVO based on stroke alert related phone calls received by the Emergency Medical Service (EMS). The objective was to create a useful prehospital tool to triage of LVO. METHODS. Two epidemiological registers of the Alpine North Emergency Network were studied to establish a cohort of patients calling EMS for suspected stroke lasting less than 6 hours. Variables selected for clinical relevance were retrospectively collected. After logistic regression, we have created the Alpha Stroke Score (ASS) with variables showing a significant link with the presence of LVO. RESULTS. 1,118 patients were included during the year 2014. Out of 511 cases with an ischemic stroke, 129 were shown to have LVO. The significant variables are: motor deficit of the right lower limb or left lower limb (OR = 1.54 [0.86-2.68], p = 0.147; OR = 1.81 [1.01-3.18], p = 0.129 respectively), language disorder (OR = 1.53 [0.91-2.64], p = 0.107), active smoking (OR = 2.20 [1.19-3.91], p = 0.020), an elapsed time of less than 30 minutes between the deficit onset and the emergency call (OR = 2.09 [1.25 -3.59], p = 0.002) and the fact that the caller is not the patient himself (OR = 2.53 [0.99-8.60], p = 0.029). The ASS consists of six items. ASS > 7 has a specificity of 85% and a sensitivity of 48% for the presence of LVO. CONCLUSION. The ASS is a simple tool available to EMS to assist in the prehospital triage of LVO.
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Master Thesis
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Alphane Baquerre. Régulation téléphonique des AVC : outil d’aide au triage des occlusions des gros troncs supra aortiques (Alpha Stroke Score). Médecine humaine et pathologie. 2017. ⟨dumas-01629461⟩

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