Simplified 8-item NIHSS to identify acute

ischemic stroke patients with large vessel

occlusion: a pilot study

Jelle Demeestere, MD

Neurovascular fellow, John Hunter Hospital, Newcastle, NSW, Australia

Introductiont-PA

Introduction

• The ideal screening tool

– Fast

– Objective

– Highly reproducable

– High sensitivity and specificity for large vessel occlusion

– Based on widely used patient assessment methods

– Easy to use by different medical professional and

ambulance officers/paramedics

PAST protocol, 2010Pre-hospital Ambulance aSsessment and rapid Triage protocol

Garnett AR, Marsden DL, Parsons MW, Quain DA,

Spratt NJ, Loudfoot AR et al. The rural prehospital acute

stroke triage (PAST) trial protocol: a controlled trial for rapid

facilitated transport of rural acute stroke patients to a regional

stroke centre. Int J Stroke. 2010;5:506-513.

Interrater agreement

- Overall agreement

- Agreement when used as a cut-off

50 patients, near-simultaneous & blinded assessment

Validation of the NIHSS8 score

235 pt

? Large Vessel

Occlusion

Validation of the NIHSS8 score

Validation of the NIHSS8 score

AUC = 0.83

ROC

Validation of the NIHSS8 score

Sensitivity & specificity

vs accuracy

Validation of the NIHSS8 score

Summary and take-home points

• Endovascular treatment: powerful but limited– Time

– Availability

• Early large vessel occlusion detection in pre-hospital

phase may change treatment plan

• NIHSS8: reliable, fast, good LVO prediction

Future directions and limitations

• Need for prospective trial– confirm patient benefit

– determine optimal distance/time limit

– Proof for endovascular therapy only in specific subset of

patients?

• Dependent on regional stroke facilities– Use of thrombolytic therapy

– Performance

Thank you for your kind attention.

Questions?

Prognosis in stroke (not LVO only) with thrombolysis

Time-dependency of endovascular treatment

Prabhakaran JAMA 2015

Interrater agreement

Possible comments