BMC Emerg Med:评估急性中风的临床工具的诊断准确性:系统性回顾

2020-04-07 MedSci原创 MedSci原创

急性缺血性脑卒中的再灌注治疗具有很强的时效性,需要尽早识别符合条件的患者,以确保更好的治疗效果。因此,一些临床评估工具已经被开发出来,本综述考察了它们的诊断能力。

急性缺血性脑卒中的再灌注治疗具有很强的时效性,需要尽早识别符合条件的患者,以确保更好的治疗效果。因此,一些临床评估工具已经被开发出来,本综述考察了它们的诊断能力。

 

对目前可用的临床工具在鉴别急性缺血性脑卒中、出血性脑卒中和脑卒中模仿症的诊断性能进行了回顾性研究。使用PubMed、EMBASE、Scopus和The Cochrane Library对2015-2018年发表的文献进行了系统检索。选取了院前和院内研究,最小样本量为300例患者报告诊断准确性的研究。

 

最终纳入了25篇文章。结果显示,大脑皮层体征(注视偏差、失语和忽视)是大血管闭塞(LVO)的重要指标。选择有LVO的受试者的敏感性值在23%到99%之间,而特异性为24%到97%。临床工具,如FAST-ED、NIHSS和RACE等结合皮层体征和运动功能障碍的临床工具显示出最佳的诊断准确性。鉴别脑卒中模拟物的工具的敏感性为44%~91%,特异性为27%~98%,其中以FABS的诊断效果最好(90%的敏感性和91%的特异性)。高血压和年轻的年龄预测脑内出血,而心房颤动和糖尿病史与缺血有关。在确定最终诊断的方法上存在差异。约有50%的研究没有明确规定指标检测评估的双盲。

 

总之,近年来,各种选择急性脑卒中受试者的临床评估工具层出不穷。利用RACE、FAST-ED和NIHSS对大脑皮层和运动功能的评估显示出选择LVO受试者的最佳诊断准确率值。可用于区分急性缺血和出血的临床工具的数据有限。FABS工具在区分急性脑卒中和脑卒中模拟物方面的诊断准确率似乎不高,FABS工具显示出最佳的诊断性能。需要进一步的院前研究,以提高临床评估的诊断效用,可能应用两步式临床评估或简单的脑部成像,如经颅超声检查等简单的脑部成像的参与,以提高临床评估的诊断效用。

 

原始出处:

 

Daria AntipovaLeila Eadie, et al., Diagnostic accuracy of clinical tools for assessment of acute stroke: a systematic review. BMC Emerg Med. 2019; 19: 49.

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    2020-04-08 智慧医人
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    2020-04-07 guging

    中风是俗称,应该称为缺血性卒中吧

    0

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