title: Clinical diagnostic tools for screening of perioperative stroke in general surgery: a systematic review.
abstract: Perioperative stroke is a devastating complication that carries high mortality and functional disability. Unfortunately, residual anaesthesia and analgesia may obscure important warning signs and may lead to a delay in the assessment and treatment of major stroke after surgery. The purpose of this review is to examine the utility of existing stroke scales, for the recognition of perioperative stroke in the general surgical population. A total of 21 stroke scales have been described in the literature. Diagnostic performance was reported in 17 scales. The majority of the stroke scales were designed to evaluate current neurological deficits after an established stroke event. Recent abbreviated stroke test, such as the Face, Arm, Speech Test (FAST), were developed to facilitate stroke identification in the emergency department. Only two stroke scales have been applied in the perioperative setting after cardiac, carotid and neurological surgeries. The modified National Institutes of Health Stroke Scale appears to be useful in detecting new subtle neurological deficits in critical care, or high dependency units after surgery. However, in the general postsurgical wards, given the concern about the workload required, abbreviated stroke tests may be more appropriate for routine regular stroke surveillance. It is hoped that these tests will provide rapid assessment of global neurological function to facilitate timely diagnosis and treatment of perioperative stroke.
authors.affiliation: Department of Anaesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China Department of Anaesthesiology, Peking University Third Hospital, Beijing, China.
authors.forename: Z
authors.initials: Z
authors.lastname: Sun
authors.affiliation: Department of Anaesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Yue
authors.affiliation: Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: C C H
authors.initials: CC
authors.lastname: Leung
authors.affiliation: Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong SAR, China mtvchan@cuhk.edu.hk.
authors.forename: M T V
authors.initials: MT
authors.lastname: Chan
authors.affiliation: Department of Anaesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA.
authors.forename: A W
authors.initials: AW
authors.lastname: Gelb
mesh_terms: D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis*; D059035:Perioperative Period; D011183:Postoperative Complications / Q000175:diagnosis*; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis*; D013514:Surgical Procedures, Operative
keywords: diagnosis: screening; diagnostic tests; perioperative period; stroke