Evaluation of the Japan urgent stroke triage score in a North American population

Introduction Ischemic and hemorrhagic strokes require different treatments which are not available at all receiving hospitals. Prehospital differentiation of these types of strokes can help optimize patient transport to the appropriate facility. The Japan Urgent Stroke Triage – 7 (JUST-7) Score has been used to help differentiate between stroke types. The objective of this study was to reconstruct a stroke screening scale that could differentiate between ischemic and hemorrhagic strokes in a North American population using the variables in the JUST and JUST-7 scores. Methods This two-state cohort of acute strokes transported by emergency medical services (EMS) included adult patients with either an ischemic or hemorrhagic stroke. Logistic regression models compared hemorrhagic to ischemic strokes using the following sets of explanatory variables: (1) the JUST-7 Score, (2) the full JUST Score variables, and (3) JUST plus sex, numbness, comorbidities, and AHA guidelines. Extraneous covariates in the full model were eliminated using backwards elimination, alpha = 0.10. The predictive power of the model was assessed with receiver operating characteristic (ROC) curves and area under the curve (AUC). AUC was compared between the full model and the model selected by backwards elimination. Results The AUC for the JUST and JUST-7 variables was 0.70 and 0.68, respectively. The AUC for JUST plus sex, numbness, comorbidities, and AHA guidelines was 0.72. When comparing neurological symptoms, patients were more likely to be diagnosed with hemorrhagic stroke when they presented with altered mental status (OR 1.88, 95% CI 1.47–2.39), headache (OR 1.82, 95% CI 1.31–2.53), systolic blood pressure ≥165mmHg (OR 2.32, 95% CI 1.82–2.94), or nausea and vomiting (OR 2.90, 95% CI 2.09–4.02). Conclusions In a North American population, the JUST-7 variables had moderate predictive power for differentiating between ischemic and hemorrhagic strokes. Patients with an elevated blood pressure, altered mental status, headache, or nausea and vomiting had greater odds of having a hemorrhagic stroke. These results may help EMS differentiate between ischemic and hemorrhagic strokes, but more research is needed to develop a robust tool that can be widely applied and help EMS clinicians select the best receiving hospital for their patients.