Open AccessStepwise stroke recognition through clinical information, vital signs, and initial labs (CIVIL): Electronic health record-based observational cohort study
Author(s) -
Sung Eun Lee,
Mihye Choi,
Hyo Jung Kang,
SeongJoon Lee,
Jin Soo Lee,
Yunhwan Lee
Publication year - 2020
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0231113
Subject(s) - stroke (engine) , medicine , blood pressure , neuroimaging , cohort , emergency medicine , intensive care medicine , psychiatry , mechanical engineering , engineering
Background Stroke recognition systems have been developed to reduce time delays, however, a comprehensive triaging score identifying stroke subtypes is needed to guide appropriate management. We aimed to develop a prehospital scoring system for rapid stroke recognition and identify stroke subtype simultaneously. Methods and findings In prospective database of regional emergency and stroke center, Clinical Information, Vital signs, and Initial Labs (CIVIL) of 1,599 patients suspected of acute stroke was analyzed from an automatically-stored electronic health record. Final confirmation was performed with neuroimaging. Using multiple regression analyses, we determined independent predictors of tier 1 (true-stroke or not), tier 2 (hemorrhagic stroke or not), and tier 3 (emergent large vessel occlusion [ELVO] or not). The diagnostic performance of the stepwise CIVIL scoring system was investigated using internal validation. A new scoring system characterized by a stepwise clinical assessment has been developed in three tiers. Tier 1 : Seven CIVIL- AS3A2P items (total score from –7 to +6) were deduced for true stroke as A ge (≥ 60 years); S troke risks without S eizure or psychiatric disease, extreme S ugar; “any A symmetry”, “not A mbulating”; abnormal blood P ressure at a cut-off point ≥ 1 with diagnostic sensitivity of 82.1%, specificity of 56.4%. Tier 2 : Four items for hemorrhagic stroke were identified as the CIVIL- MAPS indicating M ental change, A ge below 60 years, high blood P ressure, no S troke risks with cut-point ≥ 2 (sensitivity 47.5%, specificity 85.4%). Tier 3 : For ELVO diagnosis: we applied with CIVIL- GFAST items ( G aze, F ace, A rm, S peech) with cut-point ≥ 3 (sensitivity 66.5%, specificity 79.8%). The main limitation of this study is its retrospective nature and require a prospective validation of the CIVIL scoring system. Conclusions The CIVIL score is a comprehensive and versatile system that recognizes strokes and identifies the stroke subtype simultaneously.