Diagnostic performance of Glial Fibrillary Acidic Protein and Prehospital Stroke Scale for identification of stroke and stroke subtypes in an unselected patient cohort with symptom onset < 4.5 h

Henriette S Jæger; Ditte Tranberg; Karianne Larsen; Jan B Valentin; Rolf A Blauenfeldt; Sebastian Luger; Kristi G Bache; Martin F Gude

doi:10.1186/s13049-022-01065-7

Diagnostic performance of Glial Fibrillary Acidic Protein and Prehospital Stroke Scale for identification of stroke and stroke subtypes in an unselected patient cohort with symptom onset < 4.5 h

Scand J Trauma Resusc Emerg Med. 2023 Jan 5;31(1):1. doi: 10.1186/s13049-022-01065-7.

Authors

Henriette S Jæger^#^{1

2}, Ditte Tranberg^#³, Karianne Larsen^{1

2}, Jan B Valentin⁴, Rolf A Blauenfeldt⁵, Sebastian Luger⁶, Kristi G Bache^{2

7}, Martin F Gude⁸

Affiliations

¹ The Norwegian Air Ambulance Foundation, Research and Development, Oslo, Norway.
² Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
³ Department of Research and Development, Prehospital Emergency Medical Services, Central Denmark Region and Aarhus University, Olof Palmes Allé 34, 2., 8200, Aarhus N, Denmark. dittetranberg@gmail.com.
⁴ Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark.
⁵ Department of Neurology and Danish Stroke Center, Aarhus University Hospital, 8200, Aarhus, Denmark.
⁶ Department of Neurology, University Hospital Frankfurt/Goethe University Frankfurt, Frankfurt am Main, Germany.
⁷ Research and Dissemination, Østfold University College, Halden, Norway.
⁸ Department of Research and Development, Prehospital Emergency Medical Services, Central Denmark Region and Aarhus University, Olof Palmes Allé 34, 2., 8200, Aarhus N, Denmark.

^# Contributed equally.

Abstract

Introduction: Rapid identification and treatment of stroke is crucial for the outcome of the patient. We aimed to determine the performance of glial fibrillary acidic protein (GFAP) independently and in combination with the Prehospital Stroke Score (PreSS) for identification and differentiation of acute stroke within 4.5 h after symptom onset.

Patients and methods: Clinical data and serum samples were collected from the Treat-Norwegian Acute Stroke Prehospital Project (Treat-NASPP). Patients with suspected stroke and symptoms lasting ≤ 4.5 h had blood samples collected and were evaluated with the National Institutes of Health Stroke Scale prospectively. In this sub study, NIHSS was retrospectively translated into PreSS and GFAP was measured using the sensitive single molecule array (SIMOA).

Results: A total of 299 patients with suspected stroke were recruited from Treat-NASPP and included in this study (44% acute ischemic stroke (AIS), 10% intracranial hemorrhage (ICrH), 7% transient ischemic attack (TIA), and 38% stroke mimics). ICrH was identified with a cross-fold validated area under the receiver-operating characteristic curve (AUC) of 0.73 (95% CI 0.62-0.84). A decision tree with PreSS and GFAP combined, first identified patients with a low probability of stroke. Subsequently, GFAP detected patients with ICrH with a 25.0% sensitivity (95% CI 11.5-43.4) and 100.0% specificity (95% CI 98.6-100.0). Lastly, patients with large-vessel occlusion (LVO) were detected with a 55.6% sensitivity (95% CI 35.3-74.5) and 82.4% specificity (95% CI 77.3-86.7).

Conclusion: In unselected patients with suspected stroke, GFAP alone identified ICrH. Combined in a decision tree, GFAP and PreSS identified subgroups with high proportions of stroke mimics, ICrH, LVO, and AIS (non-LVO strokes).

Keywords: Diagnosis; GFAP; PreSS; Prehospital; Stroke.

MeSH terms

Brain Ischemia* / diagnosis
Emergency Medical Services*
Glial Fibrillary Acidic Protein
Humans
Intracranial Hemorrhages
Ischemic Stroke*
Prospective Studies
Retrospective Studies
Stroke* / therapy

Substances

Glial Fibrillary Acidic Protein