【摘要】 目的评价洛杉矶院前卒中筛查量表(LAPSS)在院前卒中患者诊断中的作用。方法选择院前接诊的非外伤、非妇产科疾病及非昏迷患者2035例,由经过培训的院前科医师对急性起病,并以神经症状或体征为表现的327例患者应用LAPSS进行卒中筛查。以最终临床诊断为标准,评价LAPSS对卒中诊断的灵敏度、特异度、阳性预测值、阴性预测值、似然比和Youden指数。结果①与最终临床诊断的59例为卒中比较,327例患者中漏诊12例(漏诊率20%,其中2例因观察指标重复,未重复计算),因年龄选项漏诊4例,症状持续时间选项漏诊4例,有痫性发作或癫痫病史选项漏诊1例,血糖值选项漏诊2例,神经系统体检漏诊3例;误诊4例(误诊率1.5%),均因神经系统体检误诊。②LAPSS筛查的灵敏度、特异度及Youden指数分别为80%(95%CI:76%～85%)、99%(95%CI:96%～100%)及0.78(95%CI:0.68～0.89);阳性预测值和阴性预测值分别为92%(95%CI:82%～100%)、96%(95%CI:94%～98%)。阳性似然比和阴性似然比分别为53和0.21。完成LAPSS筛查平均时间为247s。结论LAPSS对卒中患者筛查具有较高的特异性、预测值和似然比,费时少;但敏感性偏低,如对年龄、血糖值标准和神经体征检查项目,进行适当修改,可能会提高量表的敏感性,减少漏诊率。更多还原

【Abstract】 Objective To evaluate the effect of the Los Angeles Prehospital Stroke Screen(LAPSS)in prehospital diagnosis of stroke.Methods A total of 2035 patients whom without trauma,obstetric and gynecologic diseases,and coma when presented at hospital were selected.Then,the LAPSS was used to conduct stroke screening by the trained physicians for patients with acute onset of neurological symptoms and signs.The final clinical diagnosis was used as a standard,and the LAPSS was used to evaluate the sensitivity,specificity,positive predictive value,negative predictive value,likelihood ratio,and Youden index of the stroke diagnosis.Results Of the 2035 patients,327 met the LAPSS standards.They were compared to the 59 patients with final clinical diagnosis of stroke.Twelve patients were misdiagnosed(20%),of those,for age option were 4,for duration of symptom option were 4,for seizures or epilepsy history option was 1,for blood glucose value option were 2,and for nervous system examination option were 3.Four patients were misdiagnosed(1.5%)because of mistakes of nervous system examination.The sensitivity,specificity,and Youden index of LAPSS were 80%(95%CI 76% to 85%),99%(95%CI 96% to 100%),and 0.78(95%CI 0.68 to 0.89),respectively;the positive and negative predictive value were 92%(95%CI 82% to 100%)and 96%(95%CI 94% to 98%),respectively.The positive and negative likelihood ratio were 53 and 0.21,respectively.The average time to complete LAPSS was 4 minutes and 7 seconds.Conclusions The LAPSS in patients with stroke has high specificity,predicted value and likelihood ratio.It does not take much time,but the sensitivity is relatively low.If the examination items,including age,blood glucose value standard and neurological signs are modified properly,it may improve the sensitivity of the scale and reduce misdiagnosis.更多还原