title: Prediction of thrombolytic therapy after stroke-bypass transportation: the Maria Prehospital Stroke Scale score.
abstract: There is no prehospital stratification tool specifically for predicting thrombolytic therapy after transportation. We developed a new prehospital scale named the Maria Prehospital Stroke Scale (MPSS) by modifying the Cincinnati Prehospital Stroke Scale. Our objective is to evaluate its utility in a citywide bypass transportation protocol for intravenous (IV) tissue plasminogen activator (tPA). In the MPSS, facial droop, arm drift, and speech disturbance are tested by emergency medical technicians (EMTs). Facial droop is graded as normal (0) or abnormal (1), and the other 2 items are graded in 3 levels as normal (0), not severe (1), and severe (2). Thus, the total MPSS score ranges from 0 to 5. The predictive value of MPSS for thrombolytic therapy after bypass transportation was evaluated in 1057 patients. The MPSS scored by EMTs was significantly correlated with the National Institutes of Health Stroke Scale score in the emergency room (Spearman rho = .67, P = .000). The onset-to-door time was significantly longer with a low MPSS score (analysis of variance, F5,4.21 = .001). The rate of thrombolytic therapy was increased when the MPSS score increased from 0 to 5: 0%, 4.1%, 8.8%, 13.0%, 20.3%, and 31.5%, respectively. The areas under the receiver operating characteristic curve for the correct diagnosis of stroke and prediction of IV tPA therapy were calculated as .737 (95% confidence interval [CI]: .688-.786) and .689 (95% CI: .645-.732), respectively. Multivariate logistic regression analysis showed that the MPSS score and the detection-to-door time were independent predictors of tPA use after transportation. The MPSS is a novel prehospital stratification tool for the prediction of thrombolytic therapy after transportation.
authors.affiliation: Department of Neurology, St Marianna University School of Medicine, Kawasaki, Japan. shinnai@marianna-u.ac.jp
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Hasegawa
authors.forename: Naoshi
authors.initials: N
authors.lastname: Sasaki
authors.forename: Koji
authors.initials: K
authors.lastname: Yamada
authors.forename: Hajime
authors.initials: H
authors.lastname: Ono
authors.forename: Junichiro
authors.initials: J
authors.lastname: Kumai
authors.forename: Kotaro
authors.initials: K
authors.lastname: Tsumura
authors.forename: Kazunari
authors.initials: K
authors.lastname: Suzuki
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nozaki
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Nakayama
authors.forename: Ichiro
authors.initials: I
authors.lastname: Takumi
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Nikaido
authors.forename: Tuyoshi
authors.initials: T
authors.lastname: Katabami
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Ueda
authors.forename: Shinichi
authors.initials: S
authors.lastname: Suzuki
authors.forename: Ryosei
authors.initials: R
authors.lastname: Iwai
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takahashi
authors.forename: Taku
authors.initials: T
authors.lastname: Shigeno
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances; D019540:Area Under Curve; D016009:Chi-Square Distribution; D004632:Emergency Medical Services; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006305:Health Status Indicators; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012372:ROC Curve; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D013997:Time Factors; D061665:Time-to-Treatment; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014218:Triage; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator