BACKGROUND: The Stroke Network of Wisconsin (SNOW) scale, previously called the Pomona scale, was developed to predict large-vessel occlusions (LVOs) in patients with acute ischemic stroke (AIS). The original study showed a high accuracy of this scale. We sought to externally validate the SNOW scale in an independent cohort. METHODS: We retrospectively reviewed and calculated the SNOW scale, the Vision Aphasia and Neglect Scale (VAN), the Cincinnati Prehospital Stroke Severity (CPSS), the Los Angeles Motor Scale (LAMS), and the Prehospital Acute Stroke Severity Scale (PASS) for all patients who were presented within 24 hours after onset at AHCS (14 hospitals) between January 2015 and December 2016. The predictive performance of all scales and several National Institute of Health Stroke Scale cutoffs (≥6) were determined and compared. LVO was defined by total occlusions involving the intracranial internal carotid artery, middle cerebral artery (MCA; M1), or basilar arteries. RESULTS: Among 2183 AIS patients, 1381 had vascular imaging and were included in the analysis. LVO was detected in 169 (12%). A positive SNOW scale had comparable accuracy to predict LVO and showed a sensitivity of 0.80, specificity of 0.76, the positive predictive value (PPV) of 0.31, and negative predictive value of 0.96 for the detection of LVO versus CPSS ≥ 2 of 0.64, 0.87, 0.41, and 0.95. A positive SNOW scale had higher accuracy than VAN, LAMS, and PASS. CONCLUSION: In our large stroke network cohort, the SNOW scale has promising sensitivity, specificity and accuracy to predict LVO. Future prospective studies in both prehospital and emergency room settings are warranted.
BACKGROUND: The Stroke Network of Wisconsin (SNOW) scale, previously called the Pomona scale, was developed to predict large-vessel occlusions (LVOs) in patients with acute ischemic stroke (AIS). The original study showed a high accuracy of this scale. We sought to externally validate the SNOW scale in an independent cohort. METHODS: We retrospectively reviewed and calculated the SNOW scale, the Vision Aphasia and Neglect Scale (VAN), the Cincinnati Prehospital Stroke Severity (CPSS), the Los Angeles Motor Scale (LAMS), and the Prehospital Acute Stroke Severity Scale (PASS) for all patients who were presented within 24 hours after onset at AHCS (14 hospitals) between January 2015 and December 2016. The predictive performance of all scales and several National Institute of Health Stroke Scale cutoffs (≥6) were determined and compared. LVO was defined by total occlusions involving the intracranial internal carotid artery, middle cerebral artery (MCA; M1), or basilar arteries. RESULTS: Among 2183 AIS patients, 1381 had vascular imaging and were included in the analysis. LVO was detected in 169 (12%). A positive SNOW scale had comparable accuracy to predict LVO and showed a sensitivity of 0.80, specificity of 0.76, the positive predictive value (PPV) of 0.31, and negative predictive value of 0.96 for the detection of LVO versus CPSS ≥ 2 of 0.64, 0.87, 0.41, and 0.95. A positive SNOW scale had higher accuracy than VAN, LAMS, and PASS. CONCLUSION: In our large stroke network cohort, the SNOW scale has promising sensitivity, specificity and accuracy to predict LVO. Future prospective studies in both prehospital and emergency room settings are warranted.
Authors: Blanca Fuentes; María Alonso de Leciñana; Alvaro Ximénez-Carrillo; Patricia Martínez-Sánchez; Antonio Cruz-Culebras; Gustavo Zapata-Wainberg; Gerardo Ruiz-Ares; Remedios Frutos; Eduardo Fandiño; Jose L Caniego; Andrés Fernández-Prieto; Jose C Méndez; Eduardo Bárcena; Begoña Marín; Andrés García-Pastor; Fernando Díaz-Otero; Antonio Gil-Núñez; Jaime Masjuán; Jose Vivancos; Exuperio Díez-Tejedor Journal: Stroke Date: 2015-06-23 Impact factor: 7.914
Authors: Oliver C Singer; Florian Dvorak; Richard du Mesnil de Rochemont; Heiner Lanfermann; Matthias Sitzer; Tobias Neumann-Haefelin Journal: Stroke Date: 2005-02-24 Impact factor: 7.914
Authors: David S Liebeskind; Reza Jahan; Raul G Nogueira; Tudor G Jovin; Helmi L Lutsep; Jeffrey L Saver Journal: J Neurointerv Surg Date: 2015-05-11 Impact factor: 5.836
Authors: Bijen Nazliel; Sidney Starkman; David S Liebeskind; Bruce Ovbiagele; Doojin Kim; Nerses Sanossian; Latisha Ali; Brian Buck; Pablo Villablanca; Fernando Vinuela; Gary Duckwiler; Reza Jahan; Jeffrey L Saver Journal: Stroke Date: 2008-06-12 Impact factor: 7.914
Authors: William J Powers; Colin P Derdeyn; José Biller; Christopher S Coffey; Brian L Hoh; Edward C Jauch; Karen C Johnston; S Claiborne Johnston; Alexander A Khalessi; Chelsea S Kidwell; James F Meschia; Bruce Ovbiagele; Dileep R Yavagal Journal: Stroke Date: 2015-06-29 Impact factor: 10.170
Authors: Mohamed S Teleb; Anna Ver Hage; Jaqueline Carter; Mahesh V Jayaraman; Ryan A McTaggart Journal: J Neurointerv Surg Date: 2016-02-17 Impact factor: 5.836
Authors: Kessarin Panichpisal; Sarah Erpenbeck; Paul Vilar; Reji P Babygirija; Maharaj Singh; M Riccardo Colella; Richard A Rovin Journal: J Patient Cent Res Rev Date: 2022-04-18