Koster et al reported a decision tree based on elemetns from the modified NIHSS. It can help to identify patients with large vessel occlusion who may benefit from thrombectomy. The authors are from multiple institutions in the Netherlands.
GACE = Gaze, facial Asymmetry, level of Consciousness, Extinction/inattention
Patient selection: acute stroke
Outcome: large anterior vessel occlusion (LAVO)
Parameters:
(1) abnormal gaze
(2) facial asymmetry
(3) LOC questions, >= 1 incorrect
(4) LOC commands, >= 1 incorrect
(5) extinction and/or inattention
Gaze |
Face |
Questions |
Commands |
Extinction |
Node |
Yes |
Yes |
NA |
NA |
NA |
1 |
Yes |
No |
NA |
NA |
NA |
2 |
No |
Yes |
Yes |
Yes |
NA |
3 |
No |
Yes |
Yes |
No |
NA |
4 |
No |
Yes |
No |
NA |
Yes |
5 |
No |
Yes |
No |
NA |
No |
6 |
No |
No |
NA |
NA |
NA |
7 |
where:
• From 2 to 4 of the 5 parameters are needed to reach a terminal node.
Node |
Large Vessel |
Not Large Vessel |
1 |
17% |
6% |
2 |
1% |
3% |
3 |
3% |
2% |
3 |
3% |
3% |
5 |
3% |
2% |
6 |
5% |
19% |
7 |
4% |
29% |
Total |
36% |
64% |
Significant differences are seen in nodes 1, 6 and 7.
Performance:
• The reported area under the ROC was 0.76.
Specialty: Neurology, Emergency Medicine