急诊脑卒中识别评分量表筛选价值的探讨

目的 研究急诊脑卒中识别评分量表(the Recognition of Stroke in the Emergency Room Scale,ROSIER)对可疑脑卒中患者的快速筛选价值.方法 以辛辛那提院前脑卒中评分量表(Cincinnati Pre-hospital Stroke Scale,CPSS)为对照,急诊医师在院前和院内急救中使用ROSIER对可疑脑卒中患者进行筛查,最终诊断将根据患者的头颅CT或MRI,并结合神经专科医师意见制定.比较ROSIER和CPSS的灵敏度、特异度、阳性预测值、阴性预测值、假阳性率、假阴性率、阳性似然比、阴性似然比、相关系数等指标.结果 在本次研究的114例可疑脑卒中患者中,CPSS的敏感度76.9%,特异度69.4%,假阳性率30.6%,假阴性率23.1%,阳性似然比2.51,阴性似然比0.33,相关系数0.463;ROSIER的敏感度78.5%,特异度83.7%,假阳性率16.3%,假阴性率21.5%,阳性似然比4.81,阴性似然比0.26,相关系数0.616.参考最后诊断意见,使用ROSIER与CPSS对急诊可疑脑卒中患者进行筛选,Kappa值分别为0.622和0.463,差异有统计学意义(P<0.01),为中高度一致性,且ROSIER较CPSS关联程度要高.结论 急诊院前和院内急救中使用ROSIER对可疑脑卒中患者进行筛选要优于CPSS,在中国大陆地区使用有一定价值.

Value of the use of the ROSIER scale in a Chinese emergency department

Objective To explore the value of the use of the Recognition of Stroke in the Emergency Room (ROSIER) scale in a Chinese emergency department (ER). Methods Compared with the Cincinnati Pre-hospital Stroke Scale (CPSS), emergency physicians prospectively used the ROSIER scale for suspected stroke patients who were admitted to ER, and the final diagnosis was made by the consultant psy chiatrist after assessment and review of clinical symptomatology and brain imaging findings, which was used as the reference standard for diagnosis in the study. The sensitivity (Se), specificity (Sp), false negative rate (Fnr), false positive rate(Fpr), positive likelihood ratio(+LR), negative likelihood ratio(-LR), related coefficient (r) and so on were compared between the ROSIER scale and CPSS. Results In this study, 114 suspected stroke patients were assessed. The CPSS showed a diagnostic Se 76.9%, Sp 69.4%, Fpr 30.6%, Fnr 23.1%, +LR 2.51, -LR 0.33 and r 0.463;And the ROSIER scale showed a diagnostic Se 78.5%,Sp 83.7%, Fpr 16.3%, Fnr 21.5%, +LR 4.81, -LR 0.26 and r 0.616. According to the final diagnosis, both the CPSS and ROSIER scale were useful in the recognition of suspected stroke patients in the ER(P<0.01).The Kappa statistics of the ROSIER scale and CPSS were 0.622 and 0.463 in the study. Conclusion The ROSIER scale which was better than the CPSS was a useful stroke recognition tool in the assessment of suspected stroke patients in China.