Abstract W MP82: False Negative Results on Acute Stroke Recognition Tool Has No Impact on Stroke Prognosis
Introduction: Stroke recognition tools can be useful in expediting stroke care in the acute phase. The Los Angeles Prehospital Stroke Screen (LAPSS) is one such tool, an instrument designed to allow acute stroke identification with high sensitivity and specificity. Conversely, the impact of a negative result can potentially delay stroke recognition and treatment with unknown prognostic consequences. Hypothesis We assessed whether LAPSS status affect acute stroke care and prognosis.
Methods: We evaluated consecutive patients admitted to a tertiary hospital with acute ischemic stroke from February 2009 to March 2014. All triage nurses from the emergency department were trained in the application of LAPSS, which they documented at hospital arrival on all suspected stroke patients. When LAPSS criteria for stroke were met (LAPSS positive), the stroke code was activated. We used logistic regression analysis to investigate the influence of LAPSS results upon clinical outcome (modified Rankin Scale (mRs) < 3) at discharge.
Results: We evaluated 415 patients, 82 of whom (19%) had a negative LAPSS. Patients with positive and negative LAPSS had similar time from symptoms onset to hospital arrival. Patients with a negative LAPSS had lower National Institutes of Health Stroke Scale (NIHSS) at admission (7 [3,15] versus 0 [0,0], p<0.01), higher door to neuroimaging (42 [28,51] versus 27 [19, 44] minutes, p=0.02) and door to radiologic report times (54 [36,84] versus 37 [26, 55] minutes, p<0.01), as well as a lower length of stay (5 [2,5] versus 8 [5, 17] days, p<0.01). Only patients with a positive LAPPS (26.9%) received recanalization therapies, either intravenous thrombolysis or endovascular procedures. Age 0.98 [0.96-0.99] p=0.02, NIHSS at admission 0.78[0.73-0.82] p<0.01 and treatment with thrombolysis 2.07 [1.02-2.44] p=0.04 were independent predictors of good clinical outcome (mRS< 3) at discharge, but not LAPSS status.
Conclusion: In conclusion, patients with negative LAPPS had less severe strokes as compared to those with positive screen. Although time to neuroimaging was longer in patients with negative LAPSS, short term outcome did not seem to be affected by LAPSS status.
Author Disclosures: G.S. Silva: None. R.C.A.N. Miranda: None. R.M. Massaud: None. A.M.H. Vacari: None. M. Cendoroglo Neto: None.
- © 2015 by American Heart Association, Inc.