Prehospital Identification of Stroke Subtypes in Chinese Rural Areas.
BACKGROUND
Differentiating intracerebral hemorrhage (ICH) from cerebral infarction as early as possible is vital for the timely initiation of different treatments. This study developed an applicable model for the ambulance system to differentiate stroke subtypes.


METHODS
From 26,163 patients initially screened over 4 years, this study comprised 1989 consecutive patients with potential first-ever acute stroke with sudden onset of the focal neurological deficit, conscious or not, and given ambulance transport for admission to two county hospitals in Yutian County of Hebei Province. All the patients underwent cranial computed tomography (CT) or magnetic resonance imaging to confirm the final diagnosis based on stroke criteria. Correlation with stroke subtype clinical features was calculated and Bayes' discriminant model was applied to discriminate stroke subtypes.


RESULTS
Among the 1989 patients, 797, 689, 109, and 394 received diagnoses of cerebral infarction, ICH, subarachnoid hemorrhage, and other forms of nonstroke, respectively. A history of atrial fibrillation, vomiting, and diabetes mellitus were associated with cerebral infarction, while vomiting, systolic blood pressure ≥180 mmHg, and age <65 years were more typical of ICH. For noncomatose stroke patients, Bayes' discriminant model for stroke subtype yielded a combination of multiple items that provided 72.3% agreement in the test model and 79.3% in the validation model; for comatose patients, corresponding agreement rates were 75.4% and 73.5%.


CONCLUSIONS
The model herein presented, with multiple parameters, can predict stroke subtypes with acceptable sensitivity and specificity before CT scanning, either in alert or comatose patients. This may facilitate prehospital management for patients with stroke.
Hai-Qiang
HQ
Jin
Jin-Chao
JC
Wang
Yong-An
YA
Sun
Pu
P
Lyu
Wei
W
Cui
Yuan-Yuan
YY
Liu
Zhi-Gang
ZG
Zhen
Department of Neurology, Peking University First Hospital, Beijing 100034, China.
Yi-Ning
YN
Huang
D000368:Aged; D002543:Cerebral Hemorrhage / Q000145:classification; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D020521:Stroke / Q000145:classification* / Q000175:diagnosis; D014057:Tomography, X-Ray Computed