两种脑卒中筛查量表对急诊疑似卒中患者筛查价值的研究

摘要

Objective:To assess the utility of determining stroke mimics using the Recognition of Stroke in the Emergency Room ( ROSIER) and Facial drooping,Arm weakness,Speech difficulties and Time(FAST)scales as a stroke recognition tool in a Chinese emergency department.Methods:A total of 237 suspected stroke patients were enrolled in the Emergency Room of Wuhu No.2 People′s Hospital,and prospectively screened with ROSIER scale and FAST scale.Final diagnosis was based on the head CT or MRI findings and specialist consultants ,and the scoring on the two scales was compared pertain-ing to the sensitivity ( Se) ,specificity ( Sp) ,positive predictive value ( PPV) and negative predictive value ( NPV) .Results:In 237 cases,177 were con-firmed as stroke and 60 as stroke mimics.Scoring of the two groups on the two scales were different regarding the age,history of cigarette smoking,alcohol intake and hypertension(P<0.05).Logistic regression analysis revealed that age (OR=1.051,95%CI:1.020-1.084,P=0.001),hypertension (OR=2.721,95%CI:1.190-6.224,P=0.018) and ROSIER scale (OR=92.96,95%CI:8.098-167.064,P=0.001) were independent risk factors for stroke patients.The ROSIER scale showed a diagnostic Se,Sp,PPV and NPV of 79.66%,86.66%,94.63% and 59.09%,respectively,compared to 76.27%,81.66%,92.46% and 53.85% by FSAT.Conclusion:The ROSIER scale has superiority to FAST scale in determining the stroke mimics as a stroke recognition tool in emergency settings.%目的：探讨急诊脑卒中识别评分量表（the recognition of stroke in the emergency room ，ROSIER）和面、臂、言语、时间评分量表（ facial drooping ，arm weakness ，speech difficulties and time ，FAST）对急诊疑似卒中患者的筛查价值。方法：对237例芜湖市第二人民医院经急诊就诊疑似脑卒中患者，使用ROSIER和FAST评分量表进行筛查，并根据患者的头颅CT或磁共振，结合专科诊疗明确最终确诊，分析比较两种量表的应用价值。结果：237例患者最终确诊卒中177例，非卒中患者60例。两组患者在年龄﹑吸烟史、饮酒史、高血压、ROSIER评分、FAST评分差异有统计学意义（P均＜0．05）。 Logistic回归分析发现，年龄（OR＝1．051，95％CI：1．020～1．084，P＝0．001）﹑高血压病（OR＝2．721，95％CI：1．190～6．224，P＝0．018）和ROSIER评分（OR＝92．960，95％CI：8．098～167．064，P＝0．001）与脑卒中患者显著相关。 ROSIER评分量表的敏感度为79．66％，特异度为86．66％，阳性预测值为94．63％，阴性预测值为59．09％，FAST评分量表的敏感度为76．27％，特异度为81．66％，阳性预测值为92．46％，阴性预测值为53．85％。结论：在急诊急救中，对可疑脑卒中患者的临床筛查，ROSIER评分量表优于FAST评分量表。