Joon-Tae Kim1, Pil-Wook Chung1, Sidney Starkman1, Nerses Sanossian1, Samuel J Stratton1, Marc Eckstein1, Frank D Pratt1, Robin Conwit1, David S Liebeskind1, Latisha Sharma1, Lucas Restrepo1, May-Kim Tenser1, Miguel Valdes-Sueiras1, Jeffrey Gornbein1, Scott Hamilton1, Jeffrey L Saver2. 1. From the Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K.); Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (P.-W.C.); Department of Emergency Medicine and Neurology (S.S.), Department of Emergency (F.D.P.), Department of Neurology and Comprehensive Stroke Center (D.S.L., L.S., L.R., M.V.-S., J.L.S.), Neurovascular Imaging Research Core (D.S.L.), and Department of Biomathematics (J.G.), David Geffen School of Medicine, University of California, Los Angeles; Department of Neurology, University of Southern California, Los Angeles (N.S., M.-K.T.); Department of Emergency Medicine, Los Angeles EMS Agency, Orange County EMS Agency, Harbor-University of California, Los Angeles Medical Center (S.J.S.); Department of Emergency Medicine, Keck School of Medicine of the University of Southern California and Los Angeles Fire Department (M.E.); Los Angeles County Department of Public Health, CA (F.D.P.); National Institutes of Health, National Institutes of Neurological Disorders and Stroke, Bethesda, MD (R.C.); and School of Medicine, Stanford University, Palo Alto, CA (S.H.). 2. From the Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K.); Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (P.-W.C.); Department of Emergency Medicine and Neurology (S.S.), Department of Emergency (F.D.P.), Department of Neurology and Comprehensive Stroke Center (D.S.L., L.S., L.R., M.V.-S., J.L.S.), Neurovascular Imaging Research Core (D.S.L.), and Department of Biomathematics (J.G.), David Geffen School of Medicine, University of California, Los Angeles; Department of Neurology, University of Southern California, Los Angeles (N.S., M.-K.T.); Department of Emergency Medicine, Los Angeles EMS Agency, Orange County EMS Agency, Harbor-University of California, Los Angeles Medical Center (S.J.S.); Department of Emergency Medicine, Keck School of Medicine of the University of Southern California and Los Angeles Fire Department (M.E.); Los Angeles County Department of Public Health, CA (F.D.P.); National Institutes of Health, National Institutes of Neurological Disorders and Stroke, Bethesda, MD (R.C.); and School of Medicine, Stanford University, Palo Alto, CA (S.H.). jsaver@mednet.ucla.edu.
Abstract
BACKGROUND AND PURPOSE: The Los Angeles Motor Scale (LAMS) is a 3-item, 0- to 10-point motor stroke-deficit scale developed for prehospital use. We assessed the convergent, divergent, and predictive validity of the LAMS when performed by paramedics in the field at multiple sites in a large and diverse geographic region. METHODS: We analyzed early assessment and outcome data prospectively gathered in the FAST-MAG trial (Field Administration of Stroke Therapy-Magnesium phase 3) among patients with acute cerebrovascular disease (cerebral ischemia and intracranial hemorrhage) within 2 hours of onset, transported by 315 ambulances to 60 receiving hospitals. RESULTS: Among 1632 acute cerebrovascular disease patients (age 70±13 years, male 57.5%), time from onset to prehospital LAMS was median 30 minutes (interquartile range 20-50), onset to early postarrival (EPA) LAMS was 145 minutes (interquartile range 119-180), and onset to EPA National Institutes of Health Stroke Scale was 150 minutes (interquartile range 120-180). Between the prehospital and EPA assessments, LAMS scores were stable in 40.5%, improved in 37.6%, and worsened in 21.9%. In tests of convergent validity, against the EPA National Institutes of Health Stroke Scale, correlations were r=0.49 for the prehospital LAMS and r=0.89 for the EPA LAMS. Prehospital LAMS scores did diverge from the prehospital Glasgow Coma Scale, r=-0.22. Predictive accuracy (adjusted C statistics) for nondisabled 3-month outcome was as follows: prehospital LAMS, 0.76 (95% confidence interval 0.74-0.78); EPA LAMS, 0.85 (95% confidence interval 0.83-0.87); and EPA National Institutes of Health Stroke Scale, 0.87 (95% confidence interval 0.85-0.88). CONCLUSIONS: In this multicenter, prospective, prehospital study, the LAMS showed good to excellent convergent, divergent, and predictive validity, further establishing it as a validated instrument to characterize stroke severity in the field.
RCT Entities:
BACKGROUND AND PURPOSE: The Los Angeles Motor Scale (LAMS) is a 3-item, 0- to 10-point motor stroke-deficit scale developed for prehospital use. We assessed the convergent, divergent, and predictive validity of the LAMS when performed by paramedics in the field at multiple sites in a large and diverse geographic region. METHODS: We analyzed early assessment and outcome data prospectively gathered in the FAST-MAG trial (Field Administration of Stroke Therapy-Magnesium phase 3) among patients with acute cerebrovascular disease (cerebral ischemia and intracranial hemorrhage) within 2 hours of onset, transported by 315 ambulances to 60 receiving hospitals. RESULTS: Among 1632 acute cerebrovascular diseasepatients (age 70±13 years, male 57.5%), time from onset to prehospital LAMS was median 30 minutes (interquartile range 20-50), onset to early postarrival (EPA) LAMS was 145 minutes (interquartile range 119-180), and onset to EPA National Institutes of Health Stroke Scale was 150 minutes (interquartile range 120-180). Between the prehospital and EPA assessments, LAMS scores were stable in 40.5%, improved in 37.6%, and worsened in 21.9%. In tests of convergent validity, against the EPA National Institutes of Health Stroke Scale, correlations were r=0.49 for the prehospital LAMS and r=0.89 for the EPALAMS. Prehospital LAMS scores did diverge from the prehospital Glasgow Coma Scale, r=-0.22. Predictive accuracy (adjusted C statistics) for nondisabled 3-month outcome was as follows: prehospital LAMS, 0.76 (95% confidence interval 0.74-0.78); EPALAMS, 0.85 (95% confidence interval 0.83-0.87); and EPA National Institutes of Health Stroke Scale, 0.87 (95% confidence interval 0.85-0.88). CONCLUSIONS: In this multicenter, prospective, prehospital study, the LAMS showed good to excellent convergent, divergent, and predictive validity, further establishing it as a validated instrument to characterize stroke severity in the field.
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Authors: Christopher T Richards; Ryan Huebinger; Katie L Tataris; Joseph M Weber; Laura Eggers; Eddie Markul; Leslee Stein-Spencer; Kenneth S Pearlman; Jane L Holl; Shyam Prabhakaran Journal: Prehosp Emerg Care Date: 2018-01-03 Impact factor: 3.077
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Authors: Ali Reza Noorian; Nerses Sanossian; Kristina Shkirkova; David S Liebeskind; Marc Eckstein; Samuel J Stratton; Franklin D Pratt; Robin Conwit; Fiona Chatfield; Latisha K Sharma; Lucas Restrepo; Miguel Valdes-Sueiras; May Kim-Tenser; Sidney Starkman; Jeffrey L Saver Journal: Stroke Date: 2018-02-19 Impact factor: 7.914
Authors: Esmee Venema; Martijne H C Duvekot; Hester F Lingsma; Anouk D Rozeman; Walid Moudrous; Frederique H Vermeij; Marileen Biekart; Aad van der Lugt; Henk Kerkhoff; Diederik W J Dippel; Bob Roozenbeek Journal: BMJ Open Date: 2019-07-09 Impact factor: 2.692
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