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Master Thesis

Élaboration d'un score prédictif téléphonique d'occlusion proximale d'artère cérébrale : the stroke triage alpha rescue score (STARS)

Abstract : Endovascular thrombectomy (EVT) has become the gold standard for the treatment of acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). Its benefit is even more important as recanalization is early. However, access to EVT remains limited to a few centers, which complicate pre-hospital triage. To make it easier, we developed a prehospital telephone score predictive of LVO. We retrospectively studied baselines clinical and radiological data of all adult patients calling to Emergency Medical Communication Centers for a suspected stroke within 24 hours in the North Alps network (RENAU) territory (Isère, Savoie, Haute-Savoie) in 2014 and 2016. The LVO was confirmed by expert stroke neurologists. The items weighting was based on Odds Ratio of significant variables after multivariate analysis. The score’s performances were established thanks to an internal validation. Of 3452 patients, 1643 (48%) had an AIS, 496 (14%) had a transient ischemic attack, 368 (11%) had intracerebral haemorrhage, and 945 (27%) had stroke mimics. An LVO was found in 315 patients (9% overall,19% of AIS patients). The items retained were: 2 points for upper limb paresis, 2 for lower limb paresis, 2 for language impairment, 2 for facial palsy, 3 for disorders of consciousness and 2 for active smoking. We chose the cut off ≥ 6 for a sensitivity at 0.78 and a specificity at 0.56. The PPV was 0.15 and the NPV, 0.96. The AUC was 0.75. We designed a simple and efficient pre-hospital telephone score useful to predict LVO in stroke alerts. A prospective study is currently underway to establish an external validation.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03629356
Contributor : Jean-Hugues Morneau Connect in order to contact the contributor
Submitted on : Monday, April 4, 2022 - 12:11:45 PM
Last modification on : Wednesday, April 6, 2022 - 3:33:12 AM

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  • HAL Id : dumas-03629356, version 1

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Hugo Merlin. Élaboration d'un score prédictif téléphonique d'occlusion proximale d'artère cérébrale : the stroke triage alpha rescue score (STARS). Médecine humaine et pathologie. 2021. ⟨dumas-03629356⟩

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