Dataset Information

Los Angeles Motor Scale to Identify Large Vessel Occlusion: Prehospital Validation and Comparison With Other Screens.

ABSTRACT: BACKGROUND AND PURPOSE:Prehospital scales have been developed to identify patients with acute cerebral ischemia (ACI) because of large vessel occlusion (LVO) for direct routing to Comprehensive Stroke Centers (CSCs), but few have been validated in the prehospital setting, and their impact on routing of patients with intracranial hemorrhage has not been delineated. The purpose of this study was to validate the Los Angeles Motor Scale (LAMS) for LVO and CSC-appropriate (LVO ACI and intracranial hemorrhage patients) recognition and compare the LAMS to other scales. METHODS:The performance of the LAMS, administered prehospital by paramedics to consecutive ambulance trial patients, was assessed in identifying (1) LVOs among all patients with ACI and (2) CSC-appropriate patients among all suspected strokes. Additionally, the LAMS administered postarrival was compared concurrently with 6 other scales proposed for paramedic use and the full National Institutes of Health Stroke Scale. RESULTS:Among 94 patients, age was 70 (±13) and 49% female. Final diagnoses were ACI in 76% (because of LVO in 48% and non-LVO in 28%), intracranial hemorrhage in 19%, and neurovascular mimic in 5%. The LAMS administered by paramedics in the field performed moderately well in identifying LVO among patients with ACI (C statistic, 0.79; accuracy, 0.72) and CSC-appropriate among all suspected stroke transports (C statistic, 0.80; accuracy, 0.72). When concurrently performed in the emergency department postarrival, the LAMS showed comparable or better accuracy versus the 7 comparator scales, for LVO among ACI (accuracies LAMS, 0.70; other scales, 0.62-0.68) and CSC-appropriate (accuracies LAMS, 0.73; other scales, 0.56-0.73). CONCLUSIONS:The LAMS performed in the field by paramedics identifies LVO and CSC-appropriate patients with good accuracy. The LAMS performs comparably or better than more extended prehospital scales and the full National Institutes of Health Stroke Scale.

SUBMITTER: Noorian AR

PROVIDER: S-EPMC5829024 | biostudies-literature | 2018 Mar

REPOSITORIES: biostudies-literature

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Los Angeles Motor Scale to Identify Large Vessel Occlusion: Prehospital Validation and Comparison With Other Screens.

Noorian Ali Reza AR Sanossian Nerses N Shkirkova Kristina K Liebeskind David S DS Eckstein Marc M Stratton Samuel J SJ Pratt Franklin D FD Conwit Robin R Chatfield Fiona F Sharma Latisha K LK Restrepo Lucas L Valdes-Sueiras Miguel M Kim-Tenser May M Starkman Sidney S Saver Jeffrey L JL

Stroke 20180219 3

<h4>Background and purpose</h4>Prehospital scales have been developed to identify patients with acute cerebral ischemia (ACI) because of large vessel occlusion (LVO) for direct routing to Comprehensive Stroke Centers (CSCs), but few have been validated in the prehospital setting, and their impact on routing of patients with intracranial hemorrhage has not been delineated. The purpose of this study was to validate the Los Angeles Motor Scale (LAMS) for LVO and CSC-appropriate (LVO ACI and intracr ...[more]

PMID: 29459391

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Project description:BackgroundIn the context of demographic aging, active aging must be encouraged. In addition, the increase in life expectancy requires specific care for the elderly. Therefore, it is important to ensure appropriate training and education to caregivers. Educational institutions put value in positively influencing the attitudes and behaviours towards elderly people in order to ensure the quality of patient care in the future. Questionnaires are often used to assess attitudes. Among them, the University of California, Los Angeles Geriatrics Attitudes Scale (UCLA-GAS) was developed to assess attitudes towards older people and caring for older patients. This scale has been used to evaluate attitude of healthcare professionals and students including undergraduate physiotherapy students. To our knowledge, there is no scale that assesses the same concept in French. Therefore, this study aimed to translate and adapt the UCLA-GAS into French and to test its psychometric properties.MethodsWe conducted this study in two phases. First, we translated and adapted the UCLA-GAS from English into French following the five recommended stages of cross-cultural adaptation. Second, we validated the French version of the scale with undergraduate physiotherapy students. One hundred nineteen students participated from the first to the third academic years. We estimated reliability and validity of the scale. We performed correlation analyses between the French version of the UCLA-GAS (UCLA-GAS-F) with the Aging Stereotypes and Exercise Scale (ASES) and the Attitudes to Aging Questionnaire (AAQ).ResultsThe scale was translated and adapted into French. Results of the validation phase showed that the UCLA-GAS-F had high test-retest reliability (ICC 0.83, 95%CI 0.74-0.89), but internal consistency below 0.7 (Cronbach's alpha 0.49 to 0.57). The scale showed no ceiling or floor effect. As expected, the French version showed a weak correlation to the ASES (r = 0.28, p = .003) and to the AAQ (r = 0.32, p = .001).ConclusionsDespite low internal consistency, the French version of the UCLA-GAS showed appropriate psychometric properties. Further validation should include healthcare professionals and other healthcare students.

Project description:ImportanceThe efficacy of endovascular thrombectomy (EVT) for symptomatic large anterior vessel occlusion (sLAVO) sharply decreases with time. Because EVT is restricted to comprehensive stroke centers, prehospital triage of patients with acute stroke codes for sLAVO is crucial, and although several prediction scales are already in use, external validation, head-to-head comparison, and feasibility data are lacking.ObjectiveTo conduct external validation and head-to-head comparisons of 7 sLAVO prediction scales in the emergency medical service (EMS) setting and to assess scale feasibility by EMS paramedics.Design, setting, and participantsThis prospective cohort study was conducted between July 2018 and October 2019 in a large urban center in the Netherlands with a population of approximately 2 million people and included 2 EMSs, 3 comprehensive stroke centers, and 4 primary stroke centers. Participants were consecutive patients aged 18 years or older for whom an EMS-initiated acute stroke code was activated. Of 2812 acute stroke codes, 805 (28.6%) were excluded, because no application was used or no clinical data were available, leaving 2007 patients included in the analyses.ExposuresApplications with clinical observations filled in by EMS paramedics for each acute stroke code enabling reconstruction of the following 7 prediction scales: Los Angeles Motor Scale (LAMS); Rapid Arterial Occlusion Evaluation (RACE); Cincinnati Stroke Triage Assessment Tool; Prehospital Acute Stroke Severity (PASS); gaze-face-arm-speech-time; Field Assessment Stroke Triage for Emergency Destination; and gaze, facial asymmetry, level of consciousness, extinction/inattention.Main outcomes and measuresPlanned primary and secondary outcomes were sLAVO and feasibility rates (ie, the proportion of acute stroke codes for which the prehospital scale could be reconstructed). Predictive performance measures included accuracy, sensitivity, specificity, the Youden index, and predictive values.ResultsOf 2007 patients who received acute stroke codes (mean [SD] age, 71.1 [14.9] years; 1021 [50.9%] male), 158 (7.9%) had sLAVO. Accuracy of the scales ranged from 0.79 to 0.89, with LAMS and RACE scales yielding the highest scores. Sensitivity of the scales ranged from 38% to 62%, and specificity from 80% to 93%. Scale feasibility rates ranged from 78% to 88%, with the highest rate for the PASS scale.Conclusions and relevanceThis study found that all 7 prediction scales had good accuracy, high specificity, and low sensitivity, with LAMS and RACE being the highest scoring scales. Feasibility rates ranged between 78% and 88% and should be taken into account before implementing a scale.

Dataset Information

Los Angeles Motor Scale to Identify Large Vessel Occlusion: Prehospital Validation and Comparison With Other Screens.

Publications

Los Angeles Motor Scale to Identify Large Vessel Occlusion: Prehospital Validation and Comparison With Other Screens.

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