The non-paretic-hand-to-opposite-ear test: A simple test to detect aphasia and neglect and an indicator of large anterior vessel occlusion in patients with suspected acute stroke.
aphasia
large vessel occlusion
neglect
paramedic
stroke
Journal
Brain and behavior
ISSN: 2162-3279
Titre abrégé: Brain Behav
Pays: United States
ID NLM: 101570837
Informations de publication
Date de publication:
Mar 2024
Mar 2024
Historique:
revised:
28
01
2024
received:
20
10
2023
accepted:
04
02
2024
medline:
7
3
2024
pubmed:
7
3
2024
entrez:
7
3
2024
Statut:
ppublish
Résumé
Aphasia and neglect in combination with hemiparesis are reliable indicators of large anterior vessel occlusion (LAVO). Prehospital identification of these symptoms is generally considered difficult by emergency medical service (EMS) personnel. Therefore, we evaluated the simple non-paretic-hand-to-opposite-ear (NPE) test to identify aphasia and neglect with a single test. As the NPE test includes a test for arm paresis, we also evaluated the diagnostic ability of the NPE test to detect LAVO in patients with suspected stroke. In this prospective observational study, we performed the NPE test in 1042 patients with suspected acute stroke between May 2021 and May 2022. We analyzed the correlation between the NPE test and the aphasia/neglect items of the National Institutes of Health Stroke Scale. Additionally, the predictive values of the NPE test for LAVO detection were calculated. The NPE test showed a strong, significant correlation with both aphasia and neglect. A positive NPE test result predicted LAVO with a sensitivity of 0.70, a specificity of 0.88, and an accuracy of 0.85. Logistic regression analysis showed an odds ratio of 16.14 (95% confidence interval 10.82-24.44) for predicting LAVO. The NPE test is a simple test for the detection of both aphasia and neglect. With its predictive values for LAVO detection being comparable to the results of LAVO scores in the prehospital setting, this simple test might be a promising test for prehospital LAVO detection by EMS personnel. Further prospective prehospital validation is needed.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e3450Subventions
Organisme : Gemeinsame Bundesausschuss
ID : 01VSF19053
Informations de copyright
© 2024 The Authors. Brain and Behavior published by Wiley Periodicals LLC.
Références
Beume, L.-A., Hieber, M., Kaller, C. P., Nitschke, K., Bardutzky, J., Urbach, H., Weiller, C., & Rijntjes, M. (2018). Large vessel occlusion in acute stroke: Cortical symptoms are more sensitive prehospital indicators than motor deficits. Stroke; A Journal of Cerebral Circulation, 49, 2323-2329. https://doi.org/10.1161/STROKEAHA.118.022253
Birnbaum, L., Wampler, D., Shadman, A., De Leonni Stanonik, M., Patterson, M., Kidd, E., Tovar, J., Garza, A., Blanchard, B., Slesnick, L., Blanchette, A., & Miramontes, D. (2021). Paramedic utilization of vision, aphasia, neglect (VAN) stroke severity scale in the prehospital setting predicts emergent large vessel occlusion stroke. Journal of NeuroInterventional Surgery, 13, 505-508. https://doi.org/10.1136/neurintsurg-2020-016054
Caggiano, P., & Jehkonen, M. (2018). The ‘neglected’ personal neglect. Neuropsychology Review, 28, 417-435. https://doi.org/10.1007/s11065-018-9394-4
Dekker, L., Daems, J. D., Duvekot, M. H. C., Nguyen, T. T. M., Venema, E., Van Es, A. C. G. M., Rozeman, A. D., Moudrous, W., Dorresteijn, K. R. I. S., Hensen, J.-H. J., Bosch, J., Van Zwet, E. W., De Schryver, E. L. L. M., Kloos, L. M. H., De Laat, K. F., Aerden, L. A. M., Van Den Wijngaard, I. R., Dippel, D. W. J., Kerkhoff, H., … Zylicz, S. A. (2023). Comparison of prehospital assessment by paramedics and in-hospital assessment by physicians in suspected stroke patients: Results from 2 prospective cohort studies. Stroke; A Journal of Cerebral Circulation, 54, 2279-2285. https://doi.org/10.1161/STROKEAHA.123.042644
Dronkers, N. F., Wilkins, D. P., Van Valin, R. D., Redfern, B. B., & Jaeger, J. J. (2004). Lesion analysis of the brain areas involved in language comprehension. Cognition, 92, 145-177. https://doi.org/10.1016/j.cognition.2003.11.002
Duvekot, M. H. C., Venema, E., Rozeman, A. D., Moudrous, W., Vermeij, F. H., Biekart, M., Lingsma, H. F., Maasland, L., Wijnhoud, A. D., Mulder, L. J. M. M., Alblas, K. C. L., Van Eijkelenburg, R. P. J., Buijck, B. I., Bakker, J., Plaisier, A. S., Hensen, J.-H., Lycklama À Nijeholt, G. J., Van Doormaal, P. J., Van Es, A. C. G. M., … Van Den Biggelaar, J. (2021). Comparison of eight prehospital stroke scales to detect intracranial large-vessel occlusion in suspected stroke (PRESTO): A prospective observational study. Lancet Neurology, 20(3), 213-221. https://doi.org/10.1016/S1474-4422(20)30439-7
Grönberg, A., Henriksson, I., & Lindgren, A. (2021). Accuracy of NIH stroke scale for diagnosing aphasia. Acta Neurologica Scandinavica, 143, 375-382. https://doi.org/10.1111/ane.13388
Harbison, J., Hossain, O., Jenkinson, D., Davis, J., Louw, S. J., & Ford, G. A. (2003). Diagnostic accuracy of stroke referrals from primary care, emergency room physicians, and ambulance staff using the face arm speech test. Stroke; A Journal of Cerebral Circulation, 34, 71-76. https://doi.org/10.1161/01.STR.0000044170.46643.5E
Hou, X., Feng, X., Wang, H., & Li, Q. (2022). Mechanical thrombectomy for mild acute ischemic stroke with large-vessel occlusion: A systematic review and meta-analysis. Cerebrovascular Diseases, 51, 615-622.
Jauch, E. C., Schwamm, L. H., Panagos, P. D., Barbazzeni, J., Dickson, R., Dunne, R., Foley, J., Fraser, J. F., Lassers, G., Martin-Gill, C., O'Brien, S., Pinchalk, M., Prabhakaran, S., Richards, C. T., Taillac, P., Tsai, A. W., Yallapragada, A., Prehospital Stroke System of Care Consensus Conference. (2021). Recommendations for regional stroke destination plans in rural, suburban, and urban communities from the prehospital stroke system of care consensus conference: A consensus statement from the American Academy of Neurology, American Heart Association/American Stroke Association, American Society of Neuroradiology, National Association of EMS Physicians, National Association of State EMS Officials, Society of NeuroInterventional Surgery, and Society of Vascular and Interventional Neurology: Endorsed by the Neurocritical Care Society. Stroke; A Journal of Cerebral Circulation, 52, e133-e152.
Jia, J., Band, R., Abboud, M. E., Pajerowski, W., Guo, M., David, G., Mechem, C. C., Messé, S. R., Carr, B. G., & Mullen, M. T. (2017). Accuracy of emergency medical services dispatcher and crew diagnosis of stroke in clinical practice. Frontiers in Neurology, 8, 466. https://doi.org/10.3389/fneur.2017.00466
Larsen, K., Jaeger, H. S., Hov, M. R., Thorsen, K., Solyga, V., Lund, C. G., & Bache, K. G. (2022). Streamlining acute stroke care by introducing National Institutes of Health Stroke Scale in the emergency medical services: A prospective cohort study. Stroke; A Journal of Cerebral Circulation, 53, 2050-2057. https://doi.org/10.1161/STROKEAHA.121.036084
Lima, F. O., Silva, G. S., Furie, K. L., Frankel, M. R., Lev, M. H., Camargo, É. C. S., Haussen, D. C., Singhal, A. B., Koroshetz, W. J., Smith, W. S., & Nogueira, R. G. (2016). Field assessment stroke triage for emergency destination. Stroke; A Journal of Cerebral Circulation, 47, 1997-2002. https://doi.org/10.1161/STROKEAHA.116.013301
Moore, M. J., Vancleef, K., Shalev, N., Husain, M., & Demeyere, N. (2019). When neglect is neglected: NIHSS observational measure lacks sensitivity in identifying post-stroke unilateral neglect. Journal of Neurology, Neurosurgery, and Psychiatry, 90, 1070-1071. https://doi.org/10.1136/jnnp-2018-319668
Pérez de la Ossa, N., Carrera, D., Gorchs, M., Querol, M., Millán, M., Gomis, M., Dorado, L., López-Cancio, E., Hernández-Pérez, M., Chicharro, V., Escalada, X., Jiménez, X., & Dávalos, A. (2014). Design and validation of a prehospital stroke scale to predict large arterial occlusion. Stroke; A Journal of Cerebral Circulation, 45, 87-91.
National Institutes of Health, National Institute of Neurological Disorders and Stroke. (2003). NIH stroke scale. National Institute of Neurological Disorders and Stroke. https://www.stroke.nih.gov/documents/NIH_Stroke_Scale_508C.pdf (accessed 8 December 2022)
Nguyen, T. T. M., Van Den Wijngaard, I. R., Bosch, J., Van Belle, E., Van Zwet, E. W., Dofferhoff-Vermeulen, T., Duijndam, D., Koster, G. T., De Schryver, E. L. L. M., Kloos, L. M. H., De Laat, K. F., Aerden, L. A. M., Zylicz, S. A., Wermer, M. J. H., & Kruyt, N. D. (2021). Comparison of prehospital scales for predicting large anterior vessel occlusion in the ambulance setting. JAMA Neurology, 78(2), 157. https://doi.org/10.1001/jamaneurol.2020.4418
Purrucker, J. C., Härtig, F., Richter, H., Engelbrecht, A., Hartmann, J., Auer, J., Hametner, C., Popp, E., Ringleb, P. A., Nagel, S., & Poli, S. (2017). Design and validation of a clinical scale for prehospital stroke recognition, severity grading and prediction of large vessel occlusion: The shortened NIH Stroke Scale for emergency medical services. BMJ Open, 7, e016893. https://doi.org/10.1136/bmjopen-2017-016893
Teleb, M. S., Ver Hage, A., Carter, J., Jayaraman, M. V., & Mctaggart, R. A. (2017). Stroke vision, aphasia, neglect (VAN) assessment-A novel emergent large vessel occlusion screening tool: Pilot study and comparison with current clinical severity indices. Journal of NeuroInterventional Surgery, 9, 122-126. https://doi.org/10.1136/neurintsurg-2015-012131
Vanbellingen, T., Kersten, B., Van Hemelrijk, B., Van De Winckel, A., Bertschi, M., Müri, R., De Weerdt, W., & Bohlhalter, S. (2010). Comprehensive assessment of gesture production: A new test of upper limb apraxia (TULIA): A new test of upper limb apraxia. European Journal of Neurology, 17, 59-66. https://doi.org/10.1111/j.1468-1331.2009.02741.x
Vidale, S., & Agostoni, E. (2018). Prehospital stroke scales and large vessel occlusion: A systematic review. Acta Neurologica Scandinavica, 138(1), 24-31. https://doi.org/10.1111/ane.12908
Wasyliw, S., Whelan, R., Davy, K., Kelly, M. E., Graham, B., Gould, L., & Hunter, G. (2022). The FAST VAN for field identification of large vessel occlusion in acute stroke. Canadian Journal of Neurological Sciences, 50, 1-4.
Zachrison, K. S., & Goldstein, J. N. (2019). The white whale. Stroke; A Journal of Cerebral Circulation, 50, 1043-1044. https://doi.org/10.1161/STROKEAHA.119.025262