Background Early endovascular intervention team mobilization may reduce reperfusion times and improve clinical outcomes for patients with acute ischemic stroke (AIS) with a possible intervenable vessel occlusion (IVO). In an emergency department or mobile stroke unit, incorporating rapidly available non-contrast CT (NCCT) information with examination findings may improve the accuracy of arterial occlusion prediction scales. For this purpose, we developed a rapid and straightforward IVO predictive instrument—the T3AM2PA1 scale.
Methods The T3AM2PA1 scale was retrospectively derived from our ‘Get with the Guidelines’ database. We included all patients with acute stroke alert between January 2017 and August 2018 with a National Institutes of Health Stroke Scale (NIHSS) score between 5 and 25 inclusive. Different pre-intervention variables were collected, including itemized NIHSS and NCCT information. The T3AM2PA1 scale was also compared with other commonly used scales and was validated in a separate sequential retrospective cohort of patients with a full range of NIHSS scores.
Results 574 eligible patients from 2115 acute stroke alerts were identified. The scale was established with five items (CT hyperdense sign, parenchymal hypodensity, lateralizing hemiparesis, gaze deviation, and language disturbance), with a total score of 9. To minimize unnecessary angiography, a cut-off of ≥5 for IVO detection yielded a sensitivity of 52%, a specificity of 90%, and a positive predictive value of 76%.
Conclusions The T3AM2PA1 scale accurately predicts the presence of clinical IVO in patients with AIS. Adopting the T3AM2PA1 scale could reduce revascularization times, improve treatment outcomes, and potentially reduce disability.
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
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Contributors ZR, MM and WSB conceptualized the project by analyzing retrospective data to create the T3AM2PA1 scale. They oversaw the project and subsequent draft creation. WL, ZR, and WSB participated in data collection. RW and FD assisted in article drafting, graphical analysis, and journal submission. AW assisted in the statistical analysis and the scale establishment. ZM and YW contributed to the interpretation of the results, reviewed, and advised the drafting. ZR served as the guarantor for the project.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests WSB has received grants from Athersys, BMS, Florida High Tech Corridor, NIH, Reneuron, and VuEssence. His consulting activities include Genentech, VuEssence, with stock options in VuEssence. He has patents planned or pending with USF. His equity positions include holdings in Inur Technologies and Electron Transport Biotech. He also has a financial interest in PRIME Education. MM has received grants from the NIH and has consulted with Balt, Cerenovus, Medtronic, and Rapid Pulse. His testimony work includes Foley Mansfield and Huff Powell Bailey as clients. He has participated as an advisor for Cerenovus and Rapid Pulse. His financial holdings include Bendit Technologies, Borvo Medical, BrainQ, Endostream, Serenity Medical, Synchron, Sim & Cure, QAS AI, Quantanosis AI. ZR has received royalties for his publication on aneurysms and has lectured for Beijing Tiantan Hospital, the Chinese Stroke Association, and the Chinese Institute for Brain Research.
Provenance and peer review Not commissioned; externally peer reviewed.
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