• Yu-Chen Chiu, Ming-Ju Hsieh, Yen-Heng Lin, Sung-Chun Tang, Jen-Tang Sun, Wen-Chu Chiang, Li-Kai Tsai, Chung-Wei Lee, Yu-Ching Lee, and Jiann-Shing Jeng.
• Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
• Am J Emerg Med. 2021 Mar 1; 41: 35-39.

BackgroundIt is suggested that a prehospital scale should be utilized to identify patients with emergent large vessel occlusion (ELVO). We aimed to perform external validation of nine ELVO scales.MethodsThis single center retrospective observational study included patients with ischemic stroke visiting the emergency department (ED) within 6 h of symptom onset. Participants were excluded if individual items of the National Institute of Health Stroke Scale scores were not recorded or they did not receive brain computed tomography angiography or magnetic resonance imaging before intravenous thrombolysis or endovascular thrombectomy, and within 24 h of ED admission. The first definition of ELVO was emergent occlusion of the internal carotid artery (ICA) and middle cerebral artery segment 1 (M1). The second definition was emergent occlusion of ICA, M1, basilar artery, middle cerebral artery segment 2, anterior cerebral artery segment 1, and posterior cerebral artery segment 1. Area under the receiver operating characteristic curve (AUROC) was constructed to examine discrimination. The sensitivity, specificity, positive predictive value, and negative predictive value of the nine scales under the two ELVO definitions were calculated.ResultsA total of 1231 patients were included in the study. No significant differences were observed in the AUROC under the two ELVO definitions. However, sensitivity values of these scales were largely different, ranging from 44.56% to 93.68% under the first ELVO definition. The sensitivity values among scales were also different under the second ELVO definition.ConclusionStakeholders in the community should choose suitable scales according to their own system conditions.Copyright © 2020 Elsevier Inc. All rights reserved.

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