ABSTRACT NUMBER: ESOC2026A1106 DEVELOPMENT AND VALIDATION OF THE DAFNES SCALE: A TELEPHONE-BASED TOOL FOR PREHOSPITAL LARGE VESSEL OCCLUSION STROKE DETECTION

Abstract Background and aims: Background Early identification of large vessel occlusion (LVO) in acute ischemic stroke is crucial for optimal patient outcomes, as the effectiveness of recanalization treatments decreases dramatically with time. Currently, no validated telephone-based stroke scale exists for prehospital LVO detection by emergency medical services. Objective To develop and validate the DAFNES scale, a six-item telephone-administered tool designed for emergency operators to identify LVO stroke through interviews with patients or caregivers. Methods: Methods We conducted a prospective observational study analyzing 593 consecutive patients with suspected stroke. The DAFNES scale comprises six binary items: oculocephalic Deviation, Aphasia, Facial droop, Neglect, hEmiparesis, and State of consciousness. Results Of 593 cases, 408 were analyzed after excluding stroke mimics and hemorrhages. Among these, 185 (45.3%) had LVO and 223 (54.7%) were non-LVO. The DAFNES scale demonstrated good discriminative performance with an area under the curve (AUC) of 0.79 (95% CI: 0.75-0.83). Using a cutoff score ≥3, sensitivity was 0.78 and specificity was 0.72. Median DAFNES scores were significantly higher in LVO patients (3.0) compared to non-LVO patients (2.0, p<0.001). Conclusions The DAFNES scale shows promising performance for telephone-based prehospital LVO identification. Scores ≥3 could be triaged directly to thrombectomy-capable centers, potentially improving access to time-critical interventions. Further validation through multicenter field studies with emergency medical services is warranted Conflict of interest ALESSANDRA MURIALDO : nothing to disclose