Abstract TMP62: Utility of the Los Angeles Motor Scale to Identify Emergency Large Vessel Occlusion in Acute Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Prasannna Tadi ◽  
Pranav Reddy ◽  
Sravanthi Pemmasani ◽  
Nasir Fakhri ◽  
Matthew Siket ◽  
...  
Keyword(s):  
Los Angeles ◽  
Positive Predictive Value ◽  
Acute Stroke ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Vessel Imaging ◽  
Los Angeles Motor Scale

Introduction: Stroke is a common medical emergency. The outcome depends upon access to stroke specialists, rapid scanning, assessment, and treatments. Identification of large vessel occlusion (LVO) is critical in the selection of patients for emergency embolectomy (clot removal) in patients with acute ischemic stroke. A pre-hospital stroke severity scale, such as the Los Angeles Motor Scale (LAMS) may have utility in selecting appropriate patients for CTA, while minimizing radiation exposure risk to the population as a whole. Methods: This was a retrospective analysis of 249 consecutive code stroke activations at a comprehensive stroke center during a 3.5 month period using a LAMS cutoff of ≥4 to trigger CTA acquisition. We determined the sensitivity, specificity, positive predictive value, and negative predictive value of using LAMS to detect large vessel occlusion (LVO). Gold standard was any vessel imaging within 24 hours. Inter-rater reliability of LAMS scoring was determined by blinded scoring of physical exam data from the chart by 3 neurovascular physicians. Results: There were 249 code stroke activations during the study period: 91 acute CTAs were recommended based on LAMS scoring. 20 large vessel occlusions were detected. 158 patients did not have a CTA acutely; none had a LVO during subsequent vessel imaging. The sensitivity is 100%, negative predictive value 100%, specificity 69%, positive predictive value 22% of the LAMS triage method. Inter-rater Reliability: Shrout-Fleiss pairwise weighted kappa coefficients between the three raters on LAMS scores were 0.67, 0.55, and 0.62. Kappa coefficients for pairs of raters when LAMS were dichotomized as <3 vs 4-5 were 0.64, 0.50, and 0.71. Clinically meaningful disagreements were evident. Conclusions: Accuracy and ease-of-use makes LAMS an ideal clinical tool to rapidly assess acute stroke patients for LVO and emergency mechanical thrombectomy. LAMS demonstrated excellent sensitivity in excluding patients who did not have a LVO. Appropriate training is required to ensure accuracy of LAMS scoring by providers.

Abstract T MP59: Texas Stroke Intervention Pre-Hospital Stroke Severity Scale (aka LEGS score): A Triaging Tool for Interventional Stroke Therapy

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Alexander Venizelos ◽  
Sherman Chen ◽  
Ryan Gianatasio ◽  
Stewart Coffman ◽  
Mark Gamber ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Good Predictor ◽  
Mr Angiography ◽  
Large Vessel ◽  
Stroke Severity ◽  
Large Vessel Occlusion ◽  
Severity Scale ◽  
Vessel Occlusion

Introduction: A pre-hospital stroke severity scale that correlates well with an NIHSS of 10 or greater as well as with large vessel occlusions, but is easier and faster to perform than full NIHSS, would be a very useful triaging tool to emergency medical services (EMS). The LEGS score (Lower extremity strength, Eyes/visual fields, Gaze deviation, Speech difficulty) is a 16-point pre-hospital stroke severity scale that is a shortened NIHSS-5. Hypothesis: We assessed the hypothesis that the LEGS score was a useful pre-hospital stroke severity scoring system to identify large vessel acute ischemic strokes. Methods: The LEGS score (0-16) and NIHSS (0-42) were performed in the emergency department over a 6-month period. We retrospectively reviewed those charts for correlation to an NIHSS of 10 or greater and evidence of large-vessel occlusion on either CT or MR Angiography within 48 hours of last known normal. Results: A total of 181 consecutive ischemic stroke patients were evaluated. LEGS score 4 or greater was a good predictor of an NIHSS of 10 or greater (59/181; positive predictive value 92%; and specificity 95%) and false positives noted was 5/181. LEGS score of less than 4 was a good predictor of an NIHSS of less than 10 (108/181; negative predictive value 91%; and sensitivity 95%) and false negatives noted was 10/181. Of those patients 155 underwent intracranial vascular imaging. LEGS score of less than 4 was a good test to rule-out large vessel occlusion (negative predictive value of 86%; 89/103), but had modest sensitivity (69%; 31/45) and positive predictive value (60%; 31/52). The LEGS score of 4 or greater, however, was fairly specific for determining large-vessel occlusions at 81% (89/110). Conclusions: LEGS score of 4 or greater has good correlation with an NIHSS of 10 or greater as well as modest correlation with large vessel occlusion on CT or MR Angiography. This shortened NIHSS-5 may be a useful pre-hospital indicator of patients who may benefit from endovascular intervention.

scholarly journals 285 Predictive Value of the Los Angeles Motor Scale for Large Vessel Occlusion Strokes

2018 ◽  
Vol 72 (4) ◽  
pp. S112-S113
Author(s):  
P. Banerjee ◽  
L. Ganti ◽  
J. Rosario ◽  
M. Wallen ◽  
L. Dub ◽  
...  
Keyword(s):  
Los Angeles ◽  
Predictive Value ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Los Angeles Motor Scale

scholarly journals Deep Learning Based Software to Identify Large Vessel Occlusion on Noncontrast Computed Tomography

Stroke ◽  
2020 ◽  
Vol 51 (10) ◽  
pp. 3133-3137
Author(s):  
Marta Olive-Gadea ◽  
Carlos Crespo ◽  
Cristina Granes ◽  
Maria Hernandez-Perez ◽  
Natalia Pérez de la Ossa ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Deep Learning ◽  
Positive Predictive Value ◽  
Acute Stroke ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Learning Algorithm ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Noncontrast Computed Tomography

Background and Purpose: Reliable recognition of large vessel occlusion (LVO) on noncontrast computed tomography (NCCT) may accelerate identification of endovascular treatment candidates. We aim to validate a machine learning algorithm (MethinksLVO) to identify LVO on NCCT. Methods: Patients with suspected acute stroke who underwent NCCT and computed tomography angiography (CTA) were included. Software detection of LVO (MethinksLVO) on NCCT was tested against the CTA readings of 2 experienced radiologists (NR-CTA). We used a deep learning algorithm to identify clot signs on NCCT. The software image output trained a binary classifier to determine LVO on NCCT. We studied software accuracy when adding National Institutes of Health Stroke Scale and time from onset to the model (MethinksLVO+). Results: From 1453 patients, 823 (57%) had LVO by NR-CTA. The area under the curve for the identification of LVO with MethinksLVO was 0.87 (sensitivity: 83%, specificity: 71%, positive predictive value: 79%, negative predictive value: 76%) and improved to 0.91 with MethinksLVO+ (sensitivity: 83%, specificity: 85%, positive predictive value: 88%, negative predictive value: 79%). Conclusions: In patients with suspected acute stroke, MethinksLVO software can rapidly and reliably predict LVO. MethinksLVO could reduce the need to perform CTA, generate alarms, and increase the efficiency of patient transfers in stroke networks.

scholarly journals Pomona Large Vessel Occlusion Screening Tool for Prehospital and Emergency Room Settings

2018 ◽  
Vol 7 (3-4) ◽  
pp. 196-203 ◽  
Author(s):  
Kessarin Panichpisal ◽  
Kenneth Nugent ◽  
Maharaj Singh ◽  
Richard Rovin ◽  
Reji Babygirija ◽  
...  
Keyword(s):  
Los Angeles ◽  
Acute Stroke ◽  
Predictive Value ◽  
Area Under The Curve ◽  
Predictive Performance ◽  
Large Vessel ◽  
Stroke Severity ◽  
Vessel Occlusion ◽  
Comparable Accuracy ◽  
Score Model

Background: Early identification of patients with acute ischemic strokes due to large vessel occlusions (LVO) is critical. We propose a simple risk score model to predict LVO. Method: The proposed scale (Pomona Scale) ranges from 0 to 3 and includes 3 items: gaze deviation, expressive aphasia, and neglect. We reviewed a cohort of all acute stroke activation patients between February 2014 and January 2016. The predictive performance of the Pomona Scale was determined and compared with several National Institutes of Health Stroke Scale (NIHSS) cutoffs (≥4, ≥6, ≥8, and ≥10), the Los Angeles Motor Scale (LAMS), the Cincinnati Prehospital Stroke Severity (CPSS) scale, the Vision Aphasia and Neglect Scale (VAN), and the Prehospital Acute Stroke Severity Scale (PASS). Results: LVO was detected in 94 of 776 acute stroke activations (12%). A Pomona Scale ≥2 had comparable accuracy to predict LVO as the VAN and CPSS scales and higher accuracy than Pomona Scale ≥1, LAMS, PASS, and NIHSS. A Pomona Scale ≥2 had an accuracy (area under the curve) of 0.79, a sensitivity of 0.86, a specificity of 0.70, a positive predictive value of 0.71, and a negative predictive value of 0.97 for the detection of LVO. We also found that the presence of either neglect or gaze deviation alone had comparable accuracy of 0.79 as Pomona Scale ≥2 to detect LVO. Conclusion: The Pomona Scale is a simple and accurate scale to predict LVO. In addition, the presence of either gaze deviation or neglect also suggests the possibility of LVO.

120 Prospective study determining the predictive value of inattention in the evaluation of suspected acute stroke; a territory wide study

2019 ◽  
Vol 90 (e7) ◽  
pp. A39.1-A39
Author(s):  
Jonathan JD Baird-Gunning ◽  
Shaun Zhai ◽  
Brett Jones ◽  
Neha Nandal ◽  
Chandi Das ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Predictive Value ◽  
Strong Predictor ◽  
Large Vessel ◽  
List Type ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Predictive Values ◽  
Stroke Mimics

Introduction25%-30% of patients admitted with acute stroke are stroke mimics. Clinical assessment plays a major role in diagnosis in the hyperacute clinical setting. Identifying physical signs that correctly identify stroke is therefore important. A retrospective study1 suggested that the presence of sensory inattention (or neglect) was seen exclusively in stroke patients, suggesting that inattention might be a reliable discriminator between stroke and mimics. This study aimed to test that hypothesis.MethodsProspective assessment of suspected stroke patients for the presence of neglect (NIHSS definition). Neglect could be visual and/or somatosensory. The presence of neglect was then correlated with eventual diagnosis at 48 hours. Sensitivity, specificity and predictive values were calculated. A post-hoc analysis evaluated the correlation of neglect with large vessel occlusion in patients who underwent angiography.Results115 patients were recruited, 70 ultimately with stroke and 45 with other diagnoses. Neglect was present in 27 patients (of whom 23 had stroke) and absent in 88. This yielded: sensitivity 32.9%, specificity 91.1%, positive predictive value 85.2%, and negative predictive value 41.9%. Two patients with neglect had a diagnosis of functional illness, one a seizure, and one a brain tumour. Neglect was present in 7 out of 8 patients with large vessel occlusion (sensitivity 87.5%) and was absent in all patients who did not have large vessel occlusion on angiogram.ConclusionWhen present, neglect is a strong predictor of organic pathology and large vessel occlusion. However, it is not 100% specific and can be seen in functional presentations.ReferenceGargalas S, Weeks R, Khan-Bourne N, Shotbolt P, Simblett S, Ashraf L, Doyle C, Bancroft V, David AS: Incidence and outcome of functional stroke mimics admitted to a hyperacute stroke unit. J Neurol Neurosurg Psychiatry 2017, 88:2–6.

scholarly journals The Addition of Atrial Fibrillation to the Los Angeles Motor Scale May Improve Prediction of Large Vessel Occlusion

2019 ◽  
Author(s):  
Priya Narwal ◽  
Andrew D. Chang ◽  
Brian Mac Grory ◽  
Mahesh Jayaraman ◽  
Tracy Madsen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Los Angeles ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Los Angeles Motor Scale

Abstract TMP71: The Los Angeles Motor Scale - Atrial Fibrillation (LAMS-AF) Score is Superior to LAMS in Predicting Large Vessel Occlusion

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Priya Narwal ◽  
Andrew Chang ◽  
Brian Mac Grory ◽  
Mahesh Jayaraman ◽  
Ryan McTaggart ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Los Angeles ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Los Angeles Motor Scale

scholarly journals Retrospective Validation of Prehospital Acute Stroke Severity Scale to Predict Large Vessel Occlusion in Acute Stroke Patients - Single Center study in China

2019 ◽  
Author(s):  
Xiaoli Si ◽  
Yuanjian Fang ◽  
Wenqing Xia ◽  
Tianwen Chen ◽  
Huan Huang ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Predictive Value ◽  
Large Vessel ◽  
Motor Deficits ◽  
Stroke Severity ◽  
Large Vessel Occlusion ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Consciousness Disorder ◽  
Gaze Palsy

Abstract Background and Purpose - To date, identifying emergent large vessel occlusion (ELVO) patients in the prehospital stage is important but still challenging. We aimed to retrospectively validate a simple prehospital stroke scale——Prehospital Acute Stroke Severity (PASS) scale to identify ELVO. Methods - We retrospectively evaluated our consecutive cohort of acute ischemic stroke (AIS) who underwent CT angiography (CTA), MR angiography (MRA) or digital subtraction angiography (DSA). PASS scale was calculated based on National Institutes of Health Stroke Scale (NIHSS) items retrospectively. The comparison of diagnostic parameters between PASS scale and NIHSS scale were performed. Results - Finally, a total of 605 patients were enrolled. ELVO patients with PASS≥2 had a median NIHSS score of 14. The best predictive value of PASS≥2 showed a similar predictive value compared with NIHSS≥9. Cortical symptoms such as consciousness disorder and gaze palsy were more specific indicators for ELVO than motor deficits. Consciousness disorder was more serious in posterior circulation infarct (PIC) while gaze palsy was more common in anterior circulation infarct (AIC). Conclusions - PASS scale had both good discrimination and calibration in our retrospective cohort. It could reflect acute stroke severity well and predict ELVO in an effective and simple way. Moreover, cortical symptoms had high specificities to predict ELVO on their own.

scholarly journals Correlation of Alberta Stroke Program Early Computed Tomography Score With Computed Tomography Perfusion Core in Large Vessel Occlusion in Delayed Time Windows

Stroke ◽  
2021 ◽  
Author(s):  
Sriharsha Voleti ◽  
Johnathan Vidovich ◽  
Brendan Corcoran ◽  
Bin Zhang ◽  
Vivek Khandwala ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Time Windows ◽  
Interquartile Range ◽  
Large Vessel ◽  
Moderate Correlation ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Delayed Time

Background and Purpose: The Alberta Stroke Program Early Computed Tomography (CT) Score (ASPECTS) and CT perfusion (CTP) are commonly used to predict the ischemic core in acute ischemic strokes. CT angiography source images (CTA-SI) can also provide additional information to identify the extent of ischemia. Our objective was to investigate the correlation of noncontrast CT (NCCT) ASPECTS and CTA-SI ASPECTS with CTP core volumes. Methods: We utilized a single institutional, retrospective registry of consecutive patients with acute ischemic stroke with large vessel occlusion between May 2016 and May 2018. We graded ASPECTS both on baseline NCCT and CTA-SI and measured CTP core using automated RAPID software (cerebral blood flow <30%). We used Spearman’s correlation coefficients to evaluate the correlation between continuous variables. Results: A total of 52 patients fit the inclusion criteria of large vessel occlusion in 6 to 24 hours and baseline imaging work up of NCCT, CTA, and CTP. The median age was 63 (interquartile range=53.5–75) and 38.46% were female. The median NCCT ASPECTS was 7 (interquartile range=6–9), CTA-SI ASPECTS was 5 (interquartile range=4–7), and CTP core was 14.5 mL (interquartile range=0–46 mL). There was a moderate correlation between NCCT ASPECTS and CTP core (r s =−0.55, P <0.0001) and between CTA-SI ASPECTS and CTP core (r s =−0.50, P =0.0002). The optimal NCCT ASPECTS cutoff score to detect CTP core ≤70 mL was ≥6 (sensitivity, 0.84; specificity, 0.57; positive predictive value, 0.93; negative predictive value, 0.36) and the optimal CTA-SI ASPECTS was ≥5 (sensitivity, 0.76; specificity, 0.71; positive predictive value, 0.94; negative predictive value, 0.31). Conclusions: There was a moderate correlation between NCCT and CTA-SI ASPECTS in predicting CTP defined ischemic core in delayed time windows. Further studies are needed to determine if NCCT and CTA imaging could be used for image-based patient selection when CTP imaging is not available.

scholarly journals Utility of Leptomeningeal Collaterals in Predicting Intracranial Atherosclerosis-Related Large Vessel Occlusion in Endovascular Treatment

2020 ◽  
Vol 9 (9) ◽  
pp. 2784 ◽  
Author(s):  
Jang-Hyun Baek ◽  
Byung Moon Kim ◽  
Jin Woo Kim ◽  
Dong Joon Kim ◽  
Ji Hoe Heo ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Area Under The Curve ◽  
Large Vessel ◽  
Intracranial Atherosclerosis ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
High Negative Predictive Value ◽  
Independent Association

Earlier or preprocedural identification of occlusion pathomechanism is crucial for effective endovascular treatment. As leptomeningeal collaterals tend to develop well in chronic ischemic conditions such as intracranial atherosclerosis (ICAS), we investigated whether leptomeningeal collaterals can be a preprocedural marker of ICAS-related large vessel occlusion (ICAS-LVO) in endovascular treatment. A total of 226 patients who underwent endovascular treatment were retrospectively reviewed. We compared the pattern of leptomeningeal collaterals between patients with ICAS-LVO and without. Leptomeningeal collaterals were assessed by preprocedural computed tomography angiography (CTA) and basically categorized by three different collateral assessment methods. Better leptomeningeal collaterals were significantly associated with ICAS-LVO, although they were not independent for ICAS-LVO. When leptomeningeal collaterals were dichotomized to incomplete (<100%) and complete (100%), the latter was significantly more frequent in patients with ICAS-LVO (52.5% versus 20.4%) and remained an independent factor for ICAS-LVO (odds ratio, 3.32; 95% confidence interval, 1.52–7.26; p = 0.003). The area under the curve (AUC) value of complete leptomeningeal collateral supply was 0.660 for discrimination of ICAS-LVO. Incomplete leptomeningeal collateral supply was not likely ICAS-LVO, based on the high negative predictive value (88.6%). Considering its negative predictive value and the independent association between complete leptomeningeal collateral supply and ICAS-LVO, leptomeningeal collaterals could be helpful in the preprocedural determination of occlusion pathomechanism.

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