A new study has introduced the PreICH scale, aiming to differentiate between intracerebral hemorrhage (ICH) and large-vessel occlusion (LVO) patients during prehospital care.
Stroke remains one of the leading causes of severe disability and death worldwide. Prompt diagnosis and treatment are key factors influencing patient outcomes. Traditionally, distinguishing between ICH and LVO can be challenging even for experienced medical professionals. This is particularly problematic as misidentifying stroke types can lead to delays in receiving appropriate care, adversely affecting recovery chances.
To address this pressing issue, researchers conducted a prospective cohort study at the Hospital Universitari Arnau de Vilanova de Lleida, Spain, collecting data on stroke patients from May 2021 to January 2023. The aim was to develop and validate the PreICH scale, which seeks to utilize easily collectible clinical variables to improve the initial assessment of stroke patients.
The study included 285 patients who were treated under stroke code protocols. Results from this evaluation showed distinct factors associated with ICH and LVO. For example, the analysis indicated variables such as severe headache, significant elevation of systolic blood pressure, low Glasgow Coma Scale (GCS) scores, and male sex were all linked to ICH cases. Conversely, the incidence of hypercholesterolemia was uniquely associated with LVO cases.
"Our scale emphasizes its specificity to assure adequate negative predictive value," remarked the authors of the article. Through multivariate analysis, the authors discovered odds ratios for headache (3.56), reduced GCS (8.19), and high systolic blood pressure (6.43) significantly increased the likelihood of ICH.
The mathematical design for the PreICH scale assigned scores to these factors: +2 for high systolic blood pressure (>160 mm Hg), +1 for the presence of headache, +1 for being male, and +2 for reduced GCS (<8). Intriguingly, patients with prior hypercholesterolemia received -1 points. This scoring system produced positive predictive values of 21% and negative predictive values of 98%, demonstrating potential for practical application.</p>
"We present the development of a prehospital scale to discriminate between ICH and LVO patients, utilizing easily detectable variables," the authors stated, highlighting the simplicity of the proposed assessment tool. Their findings also showed the area under the curve (AUC) for the scale was 0.82, reflecting good diagnostic accuracy with the optimal cutoff at 4 points.
This study finds strong relevance as healthcare systems are becoming increasingly attentive to time-based metrics and overall quality of care delivered during emergencies. A rigorous prehospital assessment can significantly impact treatment decisions and outcomes, particularly for stroke patients facing tough prognosis. The movement toward establishing efficient evaluation systems using clinically relevant variables aligns with the growing momentum for enhancing stroke care.
While the findings of the study offer optimism for the clinical application of the PreICH scale, the authors recognize the necessity for broader validation. They stress the scale should be evaluated within diverse healthcare settings to fine-tune its predictive accuracy and applicability.
With advancements and continued research surrounding stroke management, tools like the PreICH scale hold promise for improving the accuracy of prehospital decision-making and ensuring timely access to necessary treatments for ICH and LVO patients.
Overall, the development of the PreICH scale marks an important breakthrough, potentially aiding paramedics and emergency medical responders with quick and efficient stroke type differentiation, paving the way for more confident and prompt hospital arrivals equipped with the relevant treatment protocols.