A novel scale to predict acute anterior circulation large vessel occlusion stroke for community hospitals: result from the STRESS registry

Objective To develop a simple and novel scale to predict acute anterior circulation large vessel occlusion (LVO) strokes for community hospitals in China. Methods We conducted a retrospective analysis of a prospectively collected acute ischemic stroke patient database (STRESS registry). The patients were divided into the derivation and validation cohorts. We derived a scale in the derivation cohort and assessed the scale in the validation cohort. Results A total of 1,196 patients were screened for acute ischemic stroke, 722 patients were included to the study, 406 and 316 in the derivation and validation cohorts, respectively. Multivariable logistic regression analysis identified gaze deviation [odds ratio (OR): 5.66, 95% confidence interval (CI): 2.79–11.50], motor arm weakness (OR: 4.17, 95% CI: 1.17–14.87), atrial fibrillation (OR: 4.10, 95% CI: 2.12–7.90), and level of consciousness (OR: 3.76, 95% CI: 1.56–9.04) were significantly associated with acute anterior circulation large vessel occlusion stroke. Therefore, a four-item community hospitals stroke scale was developed, including consciousness, eye gaze, arm weakness, and atrial fibrillation (CEA 2 ). In the validation cohort, the Youden index, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CEA 2 ≥ 2 in predicting anterior circulation LVO strokes were 0.722, 0.878 (95% CI 0.818–0.921), 0.844 (95% CI 0.745–0.865), 0.846 (95% CI 0.755–0.871), 0.876 (95% CI 0.809–0.917), and 0.861 (95% CI 0.801–0.881), respectively. Further analysis revealed that when the CEA 2 score, including atrial fibrillation, was ≥ 2, the sensitivity, specificity, and accuracy for predicting cardiogenic embolism etiology were 0.792(95% CI 0.722–0.850), 0.849 (95% CI 0.785–0.899), and 0.821 (95% CI 0.773–0.862), respectively. Conclusion The CEA 2 scale may be a simple and effective tool that identifies anterior circulation LVO strokes and provides relevant etiology information for community hospitals in China.