急性卒中患者院前应用NIHSS的准确性分析
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摘要
目的:探讨院前应用NIHSS的准确性。方法:依据国际疾病分类第10次修订本的编码,筛选出2017-01-01—12-31期间经镇江市急救中心救治的所有符合纳入标准的脑卒中患者的病例资料进行分析,分析内容主要为院前和院内的NIHSS评分在卒中急性期的一致性程度。结果:共有77例急性卒中患者,其中男43例,女34例;年龄35～87岁,平均(69±14)岁。院前与院内评分的平均数值差异为0.6分,符合范围为-4.2～5.4分。院前院内的评分者间一致性(K)为0.84(二次加权)。在现场对患者初步评估到完成NIHSS评分的时间中位数(四分位数)为6(4,11)min。NIHSS评分的时间中位数(四分位数)为3(2,6)min。从症状发作到院前NIHSS评分的时间中位数(四分位数)为36(15,59)min。院前和院内NIHSS评分之间的时间间隔中位数(四分位数)为40(32,48)min。结论:院前院内NIHSS评分一致性较好,院前急救医师可以独立使用NIHSS作为院前量化急性卒中神经症状的可靠临床工具。
Objective: To discuss the accuracy of pre-hospital application of NIHSS. Method:According to the ICD-10 code,all the stroke patients who were treated by Zhenjiang Emergency Center from January 1 to December 31,2017 were selected and analyzed.Analysis of the main content for the pre-hospital and in-hospital NIHSS score in the acute stage of stroke consistency. Result:There were 77 patients with acute stroke,including 43 males and 34 females,with an average age of(69±14)years,ranging from 35 to 87 years old.The average difference of pre-hospital score and in-hospital score was 0.6 points,and the coincidence range was-4.2 points and 5.4 points.The inter-rater consistency(K)in pre-hospital and in-hospital was 0.84(twice weighted).The median(quartile)time between initial assessment and completion of the NIHSS score was 6 minutes(4,11 minutes).The median NIHSS score time(quartile)was 3 minutes(2,6 minutes).The median time from onset to pre-hospital NIHSS score(quartile)was 36 minutes(15,59 minutes).The median interval between pre-hospital and in-hospital NIHSS scores was 40 minutes(32,48 minutes).Conclusion:Pre-hospital emergency physicians can try to use NIHSS as a clinical tool to evaluate patients with acute stroke in the process of pre-hospital treatment of patients with acute stroke.
Objective: To discuss the accuracy of pre-hospital application of NIHSS. Method:According to the ICD-10 code,all the stroke patients who were treated by Zhenjiang Emergency Center from January 1 to December 31,2017 were selected and analyzed.Analysis of the main content for the pre-hospital and in-hospital NIHSS score in the acute stage of stroke consistency. Result:There were 77 patients with acute stroke,including 43 males and 34 females,with an average age of(69±14)years,ranging from 35 to 87 years old.The average difference of pre-hospital score and in-hospital score was 0.6 points,and the coincidence range was-4.2 points and 5.4 points.The inter-rater consistency(K)in pre-hospital and in-hospital was 0.84(twice weighted).The median(quartile)time between initial assessment and completion of the NIHSS score was 6 minutes(4,11 minutes).The median NIHSS score time(quartile)was 3 minutes(2,6 minutes).The median time from onset to pre-hospital NIHSS score(quartile)was 36 minutes(15,59 minutes).The median interval between pre-hospital and in-hospital NIHSS scores was 40 minutes(32,48 minutes).Conclusion:Pre-hospital emergency physicians can try to use NIHSS as a clinical tool to evaluate patients with acute stroke in the process of pre-hospital treatment of patients with acute stroke.
引文
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[3] Pride GL,Fraser JF,Gupta R,et al.Prehospital care delivery and triage of stroke with emergent large vessel occlusion(ELVO):report of the standards and guidelines committee of the Society of Neurointerventional Surgery[J].J Neurointerv Surg,2017,9(8):802-812.
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[7] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国脑出血诊治指南(2014)[J].中华神经内科杂志,2015,48(6):435-444.
[8] Giavarina D.Understanding Bland Altman analysis[J].Biochem Med,2015,25(2):141-151.
[9] Brandler ES,Sharma M,Sinert RH,et al.Prehospital stroke scales in urban environments:a systematic review[J].Neurology,2014,82(24):2241-2249.
[10] Kesinger MR,Sequeira DJ,Buffalini S,et al.Comparing National Institutes of Health Stroke Scale among a stroke team and helicopter emergency medical service providers[J].Stroke,2015,46(2):575-578.
[11] Berkhemer OA,Fransen PS,Beumer D,et al.A randomized trial of intraarterial treatment for acute ischemic stroke[J].N Engl J Med,2015,372(1):11-20.
[12] Goyal M,Menon BK,van Zwam WH,et al.Endovascular thrombectomy after large-vessel ischaemic stroke:a meta-analysis of individual patient data from five randomised trials[J].Lancet,2016,387(10029):1723-1731.
[13] Kim SK,Lee SY,Bae HJ,et al.Pre-hospital notification reduced the door-to-needle time for iv t-PA in acute ischaemic stroke[J].Eur J Neurol,2009,16(12):1331-1335.
[14] Wendt M,Ebinger M,Kunz A,et al.Improved prehospital triage of patients with stroke in a specialized stroke ambulance:results of the pre-hospital acute neurological therapy and optimization of medical care in stroke study[J].Stroke,2015,46(3):740-745.
[15] Hansen CK,Christensen A,Ovesen C,et al.Stroke severity and incidence of acute large vessel occlusions in patients with hyper-acute cerebral ischemia:results from a prospective cohort study based on CT-angiography(CTA)[J].Int J Stroke,2015,10(3):336-342.
[16] Kassem-Moussa H,Graffagnino C.Nonocclusion and spontaneous recanalization rates in acute ischemic stroke:a review of cerebral angiography studies[J].Arch Neurol,2002,59(12):1870-1873.
[17] Naess H,Kurtz M,Thomassen L,et al.Serial NIHSS scores in patients with acute cerebral infarction[J].Acta Neurol Scand,2016,133(6):415-420.
[18] Bowry R,Parker S,Rajan SS,et al.Benefits of stroke treatment using a mobile stroke unit compared with standard management:the BEST-MSU Study Run-In Phase[J].Stroke,2015,46(12):3370-3374.
[2] Medoro I,Cone DC.An analysis of EMS and ED detection of stroke[J].Prehosp Emerg Care,2017,21(4):476-480.
[3] Pride GL,Fraser JF,Gupta R,et al.Prehospital care delivery and triage of stroke with emergent large vessel occlusion(ELVO):report of the standards and guidelines committee of the Society of Neurointerventional Surgery[J].J Neurointerv Surg,2017,9(8):802-812.
[4] Abboud ME,Band R,Jia J,et al.Recognition of stroke by EMS is associated with improvement in emergency department quality measures[J].Prehosp Emerg Care,2016,20(6):729-736.
[5] Vanacker P,Heldner MR,Amiguet M,et al.Prediction of large vessel occlusions in acute stroke:National Institute of Health Stroke Scale is hard to beat[J].Crit Care Med,2016,44:e336-e343.
[6] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经内科杂志,2015,48(4):246-257.
[7] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国脑出血诊治指南(2014)[J].中华神经内科杂志,2015,48(6):435-444.
[8] Giavarina D.Understanding Bland Altman analysis[J].Biochem Med,2015,25(2):141-151.
[9] Brandler ES,Sharma M,Sinert RH,et al.Prehospital stroke scales in urban environments:a systematic review[J].Neurology,2014,82(24):2241-2249.
[10] Kesinger MR,Sequeira DJ,Buffalini S,et al.Comparing National Institutes of Health Stroke Scale among a stroke team and helicopter emergency medical service providers[J].Stroke,2015,46(2):575-578.
[11] Berkhemer OA,Fransen PS,Beumer D,et al.A randomized trial of intraarterial treatment for acute ischemic stroke[J].N Engl J Med,2015,372(1):11-20.
[12] Goyal M,Menon BK,van Zwam WH,et al.Endovascular thrombectomy after large-vessel ischaemic stroke:a meta-analysis of individual patient data from five randomised trials[J].Lancet,2016,387(10029):1723-1731.
[13] Kim SK,Lee SY,Bae HJ,et al.Pre-hospital notification reduced the door-to-needle time for iv t-PA in acute ischaemic stroke[J].Eur J Neurol,2009,16(12):1331-1335.
[14] Wendt M,Ebinger M,Kunz A,et al.Improved prehospital triage of patients with stroke in a specialized stroke ambulance:results of the pre-hospital acute neurological therapy and optimization of medical care in stroke study[J].Stroke,2015,46(3):740-745.
[15] Hansen CK,Christensen A,Ovesen C,et al.Stroke severity and incidence of acute large vessel occlusions in patients with hyper-acute cerebral ischemia:results from a prospective cohort study based on CT-angiography(CTA)[J].Int J Stroke,2015,10(3):336-342.
[16] Kassem-Moussa H,Graffagnino C.Nonocclusion and spontaneous recanalization rates in acute ischemic stroke:a review of cerebral angiography studies[J].Arch Neurol,2002,59(12):1870-1873.
[17] Naess H,Kurtz M,Thomassen L,et al.Serial NIHSS scores in patients with acute cerebral infarction[J].Acta Neurol Scand,2016,133(6):415-420.
[18] Bowry R,Parker S,Rajan SS,et al.Benefits of stroke treatment using a mobile stroke unit compared with standard management:the BEST-MSU Study Run-In Phase[J].Stroke,2015,46(12):3370-3374.