摘要
目的探讨并比较改良洛杉矶院前卒中筛查量表(MLAPSS)与辛辛那提院前卒中量表(CPSS)在院前急救的应用价值。方法选取2017年1月～2018年6月广州市番禺区何贤纪念医院收治的200例疑似卒中患者为研究对象,采用回顾性研究方法,由急诊院前医师对纳入患者随机进行MLAPSS(设为MLAPSS组,n=110)或CPSS(设为CPSS组,n=90)量表评估,以神经专科医师意见和头颅影像学检查作为最终诊断结果,比较两组院前诊断脑卒中所需时间、从呼救至专业治疗所需时间,并比较两组诊断脑卒中的灵敏度、特异性、准确度、阳性预测值、阴性预测值、Youden指数、漏诊率及误诊率,评估不同筛查量表与最终诊断的一致性。结果 MLAPSS组院前诊断脑卒中所需时间和从呼救至专业治疗所需时间均较CPSS稍长,差异无统计学意义(P> 0.05)。MLAPSS共筛查出77例脑卒中患者,33例非脑卒中患者,CPSS共筛查出56例脑卒中患者,34例非脑卒中患者;参照最终诊断结果,与CPSS相较,MLAPSS诊断脑卒中的灵敏度、特异性、准确度、阳性预测值、Youden指数明显高,而漏诊率、误诊率和阴性预测值明显低(P <0.05);两种筛查量表与最终诊断结果的一致性都为中高度(Kappa值=0.658、0.610,P <0.05)。结论 MLAPSS与CPSS在院前急救的应用中均有较好临床价值,但MLAPSS对脑卒中筛查价值更高,更具临床推广应用价值。
Objective To investigate and compare the application values of modified Los Angeles Prehospital Stroke Screen(MLAPSS)and Cincinnati Prehospital Stroke Scale(CPSS)in prehospital first aid.Methods200suspected stroke patients in Hexian Memorial Hospital of Panyu Districtfrom January2017to June2018were selected as the subjects and analyzed retrospectively.The patients were randomly assessed with MLAPSS(set as MLAPSS group,n=110)or CPSS(set as CPSS group,n=90)scale by the emergency prehospital physician,the final diagnosis was based on neurologist's opinion and cranial imaging examination.The time needed for prehospital stroke diagnosis and the time required from calling for help to professional treatment were compared between the two groups,and the sensitivity,specificity,accuracy,positive predictive value,negative predictive value,Youden index,missed diagnosis rate and misdiagnosis rate were compared between the two groups,the consistency between different screening scales and final diagnosis was evaluated.Results The time needed for prehospital stroke diagnosis and the time required from calling for help to professional treatment in MLAPSS group were little longer than those in CPSS group,the difference was not statistically significant(P>0.05).There were77stroke patients and33non-stroke patients screened by MLAPSS,and56stroke patients and34non-stroke patients screened by CPSS.According to the final diagnosis results,compared with CPSS group,the sensitivity,specificity,accuracy,positive predictive value and Youden index of MLAPSS group were significantly higher,the missed diagnosis rate,misdiagnosis rate and negative predictive values were significantly lower(P<0.05),the consistency between the two screening scales and the final diagnosis was in the medium height(Kappa=0.658,0.610,P<0.05).Conclusion The application of MLAPSS and CPSS both have good clinical value in the prehospital first aid,however,MLAPSS is more valuable for stroke screening and has more clinical application value.
作者
陈佳
何伟强
李金慧
唐开放
钟立新
李胜华
梁显胤
韩明
CHEN Jia;HE Weiqiang;LI Jinhui;TANG Kaifang;ZHONG Lixin;LI Shenghua;LIANG Xianyin;HAN Ming(Hexian Memorial Hospital of Panyu District, Guangzhou 511400, China)
出处
《中国医药科学》
2018年第21期139-142,共4页
China Medicine And Pharmacy
基金
广东省广州市番禺区科技计划项目(2017-Z04-64)
