BACKGROUND: The diagnosis of stroke or TIA in the emergency department is difficult, though important for early treatment. Circulating biomarkers might improve upon clinical assessment at admission. METHODS: We recruited symptomatic patients with suspected stroke or TIA and drew blood soon after admission. Each patient was assessed with the Face Arm Speech Test (FAST). We measured a panel of 15 circulating inflammatory, thrombotic, cardiac, and cerebral tissue damage biomarkers. Improvement in diagnostic performance was assessed by adding biomarkers to the FAST in logistic regression models to predict a final diagnosis of stroke or TIA (verified by expert review and imaging). RESULTS: 405 patients had suspected stroke: 285 with TIA or stroke (230 definite or probable ischemic stroke, 40 TIA, 15 hemorrhagic stroke) and 120 with other diagnoses. Only the markers t-PA and NT-proBNP were associated positively and significantly (p < 0.01) with a diagnosis of TIA or stroke. The FAST had a sensitivity of 82% (95% CI 78-87) and specificity of 38% (95% CI 29-46) for the diagnosis of TIA or stroke. No biomarker individually improved the sensitivity or specificity of the FAST. A model containing the FAST, age, systolic blood pressure, NT-proBNP and t-PA had a better sensitivity (88%, p < 0.006) and a better specificity (48%, p = 0.04) than the FAST test alone. CONCLUSIONS: No single blood marker improved the diagnostic performance of a validated clinical stroke scale. Panels of biomarkers may marginally improve diagnosis, but their practicability is uncertain, and requires further study.
BACKGROUND: The diagnosis of stroke or TIA in the emergency department is difficult, though important for early treatment. Circulating biomarkers might improve upon clinical assessment at admission. METHODS: We recruited symptomatic patients with suspected stroke or TIA and drew blood soon after admission. Each patient was assessed with the Face Arm Speech Test (FAST). We measured a panel of 15 circulating inflammatory, thrombotic, cardiac, and cerebral tissue damage biomarkers. Improvement in diagnostic performance was assessed by adding biomarkers to the FAST in logistic regression models to predict a final diagnosis of stroke or TIA (verified by expert review and imaging). RESULTS: 405 patients had suspected stroke: 285 with TIA or stroke (230 definite or probable ischemic stroke, 40 TIA, 15 hemorrhagic stroke) and 120 with other diagnoses. Only the markers t-PA and NT-proBNP were associated positively and significantly (p < 0.01) with a diagnosis of TIA or stroke. The FAST had a sensitivity of 82% (95% CI 78-87) and specificity of 38% (95% CI 29-46) for the diagnosis of TIA or stroke. No biomarker individually improved the sensitivity or specificity of the FAST. A model containing the FAST, age, systolic blood pressure, NT-proBNP and t-PA had a better sensitivity (88%, p < 0.006) and a better specificity (48%, p = 0.04) than the FAST test alone. CONCLUSIONS: No single blood marker improved the diagnostic performance of a validated clinical stroke scale. Panels of biomarkers may marginally improve diagnosis, but their practicability is uncertain, and requires further study.
Authors: L Servaas Dolmans; Frans H Rutten; Niels C T Koenen; Marie-Louise E L Bartelink; Johannes B Reitsma; L Jaap Kappelle; Arno W Hoes Journal: Cerebrovasc Dis Date: 2019-08-30 Impact factor: 2.762
Authors: Michael Moussouttas; Thanh T Huynh; John Khoury; Edwin W Lai; Keith Dombrowski; Scott Pello; Karel Pacak Journal: Cerebrovasc Dis Date: 2012-01-05 Impact factor: 2.762
Authors: Delia Maria Stanca; Ioan Constantin Mărginean; Olga Sorițău; Cristian Dragoș; Mariana Mărginean; Dafin Fior Mureșanu; Johannes C Vester; Alexandru Rafila Journal: J Cell Mol Med Date: 2015-06-17 Impact factor: 5.310
Authors: A M Penn; V Saly; A Trivedi; M L Lesperance; K Votova; A M Jackson; N S Croteau; R F Balshaw; M B Bibok; D S Smith; K K Lam; J Morrison; L Lu; S B Coutts; C H Borchers Journal: Transl Stroke Res Date: 2018-01-24 Impact factor: 6.829
Authors: Henrik Reinhard; Ellen Garde; Arnold Skimminge; Per Åkeson; Thomas Zoëga Ramsøy; Kaj Winther; Hans-Henrik Parving; Peter Rossing; Peter K Jacobsen Journal: Cardiovasc Diabetol Date: 2012-10-03 Impact factor: 9.951
Authors: Bruno Zecca; Clara Mandelli; Alberto Maino; Chiara Casiraghi; Giovanbattista Bolla; Dario Consonni; Paola Santalucia; Giuseppe Torgano Journal: Emerg Med Int Date: 2014-03-05 Impact factor: 1.112