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Stepwise stroke recognition through clinical information, vital signs, and initial labs (CIVIL): Electronic health record-based observational cohort study

Lee, SE  | Choi, MH  | Kang, HJ | Lee, SJ  | Lee, JS  | Lee, Y  | Hong, JM
PloS one, 15(4). : e0231113-e0231113, 2020
Journal Title
PloS one
BACKGROUND: Stroke recognition systems have been developed to reduce time delays, however, a comprehensive triaging score identifying stroke subtypes is needed to guide appropriate management. We aimed to develop a prehospital scoring system for rapid stroke recognition and identify stroke subtype simultaneously.

METHODS AND FINDINGS: In prospective database of regional emergency and stroke center, Clinical Information, Vital signs, and Initial Labs (CIVIL) of 1,599 patients suspected of acute stroke was analyzed from an automatically-stored electronic health record. Final confirmation was performed with neuroimaging. Using multiple regression analyses, we determined independent predictors of tier 1 (true-stroke or not), tier 2 (hemorrhagic stroke or not), and tier 3 (emergent large vessel occlusion [ELVO] or not). The diagnostic performance of the stepwise CIVIL scoring system was investigated using internal validation. A new scoring system characterized by a stepwise clinical assessment has been developed in three tiers. Tier 1: Seven CIVIL-AS3A2P items (total score from -7 to +6) were deduced for true stroke as Age (>/= 60 years); Stroke risks without Seizure or psychiatric disease, extreme Sugar; "any Asymmetry", "not Ambulating"; abnormal blood Pressure at a cut-off point >/= 1 with diagnostic sensitivity of 82.1%, specificity of 56.4%. Tier 2: Four items for hemorrhagic stroke were identified as the CIVIL-MAPS indicating Mental change, Age below 60 years, high blood Pressure, no Stroke risks with cut-point >/= 2 (sensitivity 47.5%, specificity 85.4%). Tier 3: For ELVO diagnosis: we applied with CIVIL-GFAST items (Gaze, Face, Arm, Speech) with cut-point >/= 3 (sensitivity 66.5%, specificity 79.8%). The main limitation of this study is its retrospective nature and require a prospective validation of the CIVIL scoring system.

CONCLUSIONS: The CIVIL score is a comprehensive and versatile system that recognizes strokes and identifies the stroke subtype simultaneously.

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Journal Papers > School of Medicine / Graduate School of Medicine > Emergency Medicine
Journal Papers > School of Medicine / Graduate School of Medicine > Neurology
Journal Papers > School of Medicine / Graduate School of Medicine > Preventive Medicine & Public Health
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