فهرست مطالب yazdan baser

Large vessel occlusion (LVO) strokes are associated with worse functional outcomes and higher mortality rates. In the present systematic review and meta-analysis, we evaluated the diagnostic yield of the Cincinnati Prehospital Stroke Scale (CPSS) in detecting LVO.

We performed an extensive systematic search among online databases including Medline, Embase, Web of Science, and Scopus, until July 31st, 2023. We also conducted a manual search on Google and Google scholar, along with citation tracking to supplement the systematic search in retrieving all studies that evaluated the diagnostic accuracy of the CPSS in detecting LVO among patients suspected to stroke.

Fourteen studies were included in the present meta-analysis. CPSS showed the sensitivity of 97% (95% CI: 87%–99%) and the specificity of 17% (95% CI: 4%–54%) at the cut-off point of ≥1. The optimal threshold was determined to be ≥2, with a sensitivity of 82% (95% CI: 74%–88%) and specificity of 62% (95% CI: 48%–74%) in detecting LVO. At the highest cut-off point of ≥3, the CPSS had the lowest sensitivity of 60% (95% CI: 51%–69%) and the highest specificity of 81% (95% CI: 71%–88%). Sensitivity analyses showed the robustness of the results regardless of study population, inclusion of hemorrhagic stroke patients, pre-hospital or in-hospital settings, and the definition of LVO.

A very low level of evidence demonstrated that CPSS, with a threshold set at ≥2, is a useful tool for identifying LVO stroke and directing patients to CSCs, both in prehospital and in-hospital settings.

Deaths associated with the Acute Coronary Syndrome (ACS) remain high among Cardiac/Coronary Care Unit (CCU) and post-CCU patients. Recently, researchers have looked for inexpensive and reliable prognostic indicators as alternatives to the expensive pro-Brain Natriuretic Peptide (proBNP) in ACS patients to predict adverse outcomes. We retrieved the Complete Blood Count (CBC) records of ACS patients and calculated values for plateletcrit (PCT), Mean Platelet Volume (MPV), and Neutrophil-to-Lymphocyte Ratio (NLR). We also recorded ACS diagnostic methods, duration of hospital stays (CCU and post-CCU), and therapeutic modalities. We considered outcomes such as death, positive or negative troponin, ST-elevation, ejection fraction <45, and history of arrhythmia. The multivariate model using forward stepwise logistic regression showed that the history of arrhythmia (OR=124.052, p= 0.001), positive troponin (OR=47.545, p=0.002), hospitalization period (OR=2.376, p=0.001), C-reactive protein (CRP) (OR=1.359, p=0.001), and PCT (OR=2.018, p=0.001) are independent predictors of mortality. CRP and PCT are considered independent predictors of mortality among CCU and post-CCU patients diagnosed with ACS. However, the prognostic significance of NLR and MPV needs to be confirmed by further investigations.

In this study, we investigate the diagnostic value of the field assessment stroke triage for emergency destination (FAST-ED) tool in the diagnosis of large vessels occlusion (LVO) in a systematic review and metaanalysis.

We conducted a search in Medline (PubMed), Embase, Scopus, and Web of Science databases until the 21s t of September 2022, as well as a manual search in Google ,and Google scholar to find related articles. Studies of diagnostic value in adult population were included. Screening, data collection and quality control of articles were done by two independent researchers. The data were entered and analyzed in STATA 17.0 statistical program.

The data from 30 articles were entered. The best cut-off points for FAST-ED were 3 or 4. The sensitivity and specificity of FAST-ED at cut-off points 3 were 0.77 (95% CI:0.73,0.80) and 0.76 (95% CI:0.72,0.80), respectively. These values for cut-off point 4 were 0.72 (95% CI:0.65,0.78) and 0.79 (95% CI:0.75,0.82), respectively. Meta-regression showed that the sensitivity and specificity of FAST-ED performed by a neurologist wasmore accurate compared to emergency physician (P for sensitivity=0.01; P for specificity<0.001) and emergency medical technicians (P for sensitivity=0.03; P for specificity<0.001). Finally, it was found that the sensitivity of FAST-ED performed by the emergency physician and the emergency medical technician has no statistically significant difference (P=0.76). However, the specificity of FAST-ED reported by the emergency physician is significantly higher (P<0.001). The false negative rate of this tool at cut-off points 3 and 4 is 22.5% and 28.8%, respectively.

Although FAST-ED has an acceptable sensitivity in identifying LVO, its false negative rate varies between 22.5% and 28.8%. A percentage this high is unacceptable for a screening tool to aid in the diagnosis of strokes considering it has a high rate or morbidity and mortality. Therefore, it is recommended to use another diagnostic tool for the stroke screening.