2021 年第 4 期 第 16 卷

两种卒中筛查量表在脑卒中院前急救筛查中的应用价值

Application value of two stroke screening scales in pre-hospital emergency screening for stroke patients

作者：唐国强冉小琼曾涌王业强

英文作者：Tang Guoqiang Ran Xiaoqiong Zeng Yong Wang Yeqiang

单位：重庆市急救医疗中心重庆市第四人民医院院前急救部400010

英文单位：Department of Pre-hospital Emergency Chongqing Emergency Medical Center the Fourth People′s Hospital of Chongqing Chongqing 400010 China

关键词：脑卒中；改良洛杉矶院前卒中筛查量表；面、臂、言语、时间评分量表；院前急救 

英文关键词：Stroke;ModifiedLosAngelesprehospitalstrokescreeningscale;FaceArmSpeechTimescale;Pre-hospitalfirstaid 

• 摘要：

• 目的 探讨面、臂、言语、时间评分（FAST）量表联合改良洛杉矶院前卒中筛查量表（MLAPSS）在脑卒中院前急救筛查中的应用价值。方法 选取2019年2月至2020年6月重庆市第四人民医院急诊120出诊转送入院的1 913例疑似脑卒中患者作为研究对象，应用随机数字表法分为3组，FAST组进行院前FAST量表评估(638例)，MLAPSS组进行院前MLAPSS评估(638例)，联合组进行院前FAST量表联合MLAPSS评估(637例)。比较3组院前脑卒中筛查时间（到达现场至根据量表初步诊断时间）、转运时间（出诊至送入救治医院时间）、获得影像检查时间（出诊至入院影像检查时间）、临床确诊时间（出诊至神经内科确诊时间），以及3组院前量表评估与临床诊断结果的一致性、筛查脑卒中的效能、确诊脑卒中患者的伤残率和病死率。结果 1 913例患者中1 507例临床确诊为脑卒中，406例为非脑卒中。MLAPSS组和联合组院前脑卒中筛查时间、转运时间均长于FAST组［（3.2±0.6）、（3.9±0.7）min比（1.0±0.3）min,(42±4)、（42±4）min比（41±4）min］（均P＜0.05），3组获得影像检查时间、临床确诊时间比较差异均无统计学意义（均P＞0.05）。FAST量表和MLAPSS诊断与临床诊断结果一致性中等（Kappa=0.432、0.596，均P＜0.01），二者联合诊断与临床诊断结果一致性较高（Kappa=0.795，P＜0.001）。FAST量表联合MLAPSS评估院前筛查脑卒中的敏感度、特异度、阳性预测值、阴性预测值、准确率最高，漏诊率、误诊率最低。联合组确诊脑卒中患者伤残率低于FAST组和MLAPSS组［15.1%(76/502)比33.3%（168/504）、27.9%（140/501）］（均P＜0.01），3组确诊脑卒中患者病死率比较差异无统计学意义（P=0.081）。结论 FAST量表联合MLAPSS院前筛查脑卒中可明显提高筛查准确率，减少漏诊和误诊，降低确诊脑卒中患者伤残率。

• Objective To explore the application value of Face Arm Speech Time (FAST) scale combined with modified Los Angeles prehospital stroke screening scale (MLAPSS) in pre-hospital emergency screening of stroke. Methods From February 2019 to June 2020, 1 913 patients with suspected stroke who were transferred to hospital from emergency 120 in the Fourth People′s Hospital of Chongqing were selected. They were randomly divided into three groups: FAST group (638 cases) evaluated by pre-hospital FAST scale, MLAPSS group (638 cases) evaluated by pre-hospital MLAPSS, and combination group (637 cases) evaluated by pre-hospital FAST scale and MLAPSS. The pre-hospital stroke screening time (time from arrival at the scene to preliminary diagnosis according to the scale), transit time (time from home visit to hospital for treatment), time for obtaining imaging examination (time from home visit to admission imaging examination), time for clinical diagnosis (time from home visit to diagnosis in neurology department), the consistency between pre-hospital scale evaluation and clinical diagnosis results, effectiveness of stroke screening, and disability rate and mortality rate were compared. Results Among 1 913 patients, 1 507 cases were clinically diagnosed as stroke and 406 cases as non stroke. The pre-hospital stroke screening time and transit time in MLAPSS group and combination group were longer than those in FAST group ［(3.2±0.6), (3.9±0.7)min vs (1.0±0.3)min, (42±4), (42±4)min vs (41±4)min］(all P<0.05). There were no significant differences in the time for obtaining imaging examination and clinical diagnosis among the three groups (all P>0.05). The consistencies between FAST scale, MLAPSS diagnosis and clinical diagnosis were moderate (Kappa=0.432, 0.596, both P<0.01), and the combined diagnosis of FAST scale and MLAPSS had high consistency with clinical diagnosis(Kappa=0.795, P<0.001). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate of pre-hospital stroke screening in the combination group were the highest, and the missed diagnosis rate and misdiagnosis rate were the lowest. The disability rate of stroke patients in the combination group was lower than that in the FAST group and MLAPSS group ［15.1%(76/502) vs 33.3%(168/504), 27.9%(140/501)］(all P<0.01). There was no significant difference in the mortality rate among the three groups (P=0.081). Conclusions  FAST scale combined with MLAPSS pre-hospital screening stroke can significantly improve the accuracy of screening, reduce missed diagnosis and misdiagnosis, and reduce the disability rate of patients with confirmed stroke. But the pre-hospital screening time is longer than FAST scale alone.