Prehospital scale to differentiate intracerebral hemorrhage from large-vessel occlusion patients: A prospective cohort study

Background and rationale Evaluating scales to detect large vessel occlusion (LVO) could aid in considering early referrals to a thrombectomy-capable center in the prehospital stroke code setting. Nevertheless, they entail a significant number of false positives, corresponding to intracranial hemorrhages (ICH), which could result in a delay in medical attention and potential harm. Our study aims to identify easily collectible variables for the development of a scale to differentiate patients with ICH from LVO in a prehospital context. Methods We conducted a prospective cohort study of stroke code patients between May 2021 and January 2023. Patients were evaluated with CT/CT-Angiography at arrival. We compared clinical variables and vascular risk factors between ICH and LVO patients to design a prehospital ICH screening scale (PreICH). Results Out of 989 stroke code patients, we included 190 (66.7%) LVO cases and 95 (33.3) ICH cases. In the multivariate analysis, headache (odds ratio [OR] 3.56; 1.50-8.43), GCS<8 (OR 8.19; 3.17-21.13), SBP>160mmHg (OR 6.43; 3.37-12.26) and male sex (OR 2.07; 1.13-3.80) were associated with ICH, while previous hypercholesterolemia (HCL) (OR 0.35; 0.19-0.65) with LVO. The scale design was conducted, assigning a score to each significant variable based on its specific weight: +2 points for SBP > 160, +1 points for headache, +1 points for male sex, +2 points for GCS<8, and -1 points for HCL. The area under the curve (AUC) was 0.82 (0.77-0.87). A score ≥4 exhibited a sensitivity of 0.10, a specificity of 0.99, a positive predictive value of 0.21, and a negative predictive value of 0.98. Conclusion We present the development of a prehospital scale to discriminate between ICH and LVO patients, utilizing easily detectable variables in the prehospital setting. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial NA ### Funding Statement This study was supported by the Government of Catalonia-Agència de Gestió d’Ajuts Universitaris i de Recerca (2021SGR01479); Instituto de Salud Carlos III and co-funded by European Union (ERDF/ESF, "Investing in your future" and "A way to build Europe") (PI20/01575) and the RICORS Research Network (RD21/0006) ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: CEIC Hospital Universitari Arnau de Vilanova de LLeida I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Requests for access to the data reported in this article will be considered by the corresponding author