Validation of a simple clinical tool for screening of acute lacunar stroke—A substudy of the WAKE-UP trial

Francesco Arba; Chiara Rinaldi; Märit Jensen; Matthias Endres; Jochen B. Fiebach; Robin Lemmens; Keith W. Muir; Norbert Nighoghossian; Salvador Pedraza; Claus Z. Simonsen; Vincent Thijs; Christian Gerloff; Joanna M. Wardlaw; Götz Thomalla

doi:10.1177/17474930241253987

Validation of a simple clinical tool for screening of acute lacunar stroke—A substudy of the WAKE-UP trial

Francesco Arba^*
, Chiara Rinaldi
, Märit Jensen
, Matthias Endres
, Jochen B. Fiebach
, Robin Lemmens
, Keith W. Muir
, Norbert Nighoghossian
, Salvador Pedraza
, Claus Z. Simonsen
, Vincent Thijs
, Christian Gerloff
, Joanna M. Wardlaw
, Götz Thomalla

^*Corresponding author af dette arbejde

Institut for Klinisk Medicin - Neurologi

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

2 Citationer (Scopus)

Abstract

Introduction: Lacunar stroke represents around a quarter of all ischemic strokes; however, their identification with computed tomography in the hyperacute setting is challenging. We aimed to validate a clinical score to identify lacunar stroke in the acute setting, independently, with data from the WAKE-UP trial using magnetic resonance imaging. Methods: We analyzed data from the WAKE-UP trial and extracted Oxfordshire Community Stroke Project (OCSP) classification. Lacunar score was defined by National Institutes of Health Stroke Scale (NIHSS) < 7 and OCSP lacunar syndrome. Assessment of lacunar infarct by two independent investigators was blinded to clinical data. We calculated sensitivity, specificity, negative and positive predictive value (NPV and PPV, respectively) of lacunar score. Results: We included 503 patients in the analysis, mean (±SD) age 65.2 (±11.6) years, 325 (65%) males, median (IQR) NIHSS = 6 (4–9); 108 (22%) lacunar infarcts were identified on magnetic resonance (MR), patients fulfilling lacunar score criteria were 120 (24%), of which 47 (44%) had a lacunar infarct. Lacunar score was negative in 322 (82%) of patients without lacunar infarct. Patients with lacunar score had lower NIHSS (4 vs 7, p < 0.001), higher systolic (157 vs 151 mmHg, p = 0.001) and diastolic (86 vs 83 mmHg, p = 0.013) blood pressure and smaller infarct volume (2.4 vs 9.5 mL, p < 0.001). Performance of lacunar score was as follows: sensitivity 0.44; specificity 0.82; PPV 0.39; NPV 0.84; and accuracy 0.73. Assuming a prevalence of lacunar stroke of 13%, PPV lowered to 0.30 but NPV was 0.90. Lacunar score performed better for supratentorial lacunar infarcts. Conclusion: Lacunar score had a very good specificity and NPV for screening of lacunar stroke. Implementation of this simple tool into clinical practice may help hyperacute management and guide patient selection in clinical trials. Data access statement: Data supporting the results of this paper are available upon reasonable request to the corresponding author.

Originalsprog	Engelsk
Tidsskrift	International Journal of Stroke
Vol/bind	19
Nummer	8
Sider (fra-til)	935-941
Antal sider	7
ISSN	1747-4930
DOI	https://doi.org/10.1177/17474930241253987
Status	Udgivet - okt. 2024

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Arba, F., Rinaldi, C., Jensen, M., Endres, M., Fiebach, J. B., Lemmens, R., Muir, K. W., Nighoghossian, N., Pedraza, S., Simonsen, C. Z., Thijs, V., Gerloff, C., Wardlaw, J. M., & Thomalla, G. (2024). Validation of a simple clinical tool for screening of acute lacunar stroke—A substudy of the WAKE-UP trial. International Journal of Stroke, 19(8), 935-941. https://doi.org/10.1177/17474930241253987

@article{ccde8d994e0148cc9ad4e25a86815b14,

title = "Validation of a simple clinical tool for screening of acute lacunar stroke—A substudy of the WAKE-UP trial",

abstract = "Introduction: Lacunar stroke represents around a quarter of all ischemic strokes; however, their identification with computed tomography in the hyperacute setting is challenging. We aimed to validate a clinical score to identify lacunar stroke in the acute setting, independently, with data from the WAKE-UP trial using magnetic resonance imaging. Methods: We analyzed data from the WAKE-UP trial and extracted Oxfordshire Community Stroke Project (OCSP) classification. Lacunar score was defined by National Institutes of Health Stroke Scale (NIHSS) < 7 and OCSP lacunar syndrome. Assessment of lacunar infarct by two independent investigators was blinded to clinical data. We calculated sensitivity, specificity, negative and positive predictive value (NPV and PPV, respectively) of lacunar score. Results: We included 503 patients in the analysis, mean (±SD) age 65.2 (±11.6) years, 325 (65\%) males, median (IQR) NIHSS = 6 (4–9); 108 (22\%) lacunar infarcts were identified on magnetic resonance (MR), patients fulfilling lacunar score criteria were 120 (24\%), of which 47 (44\%) had a lacunar infarct. Lacunar score was negative in 322 (82\%) of patients without lacunar infarct. Patients with lacunar score had lower NIHSS (4 vs 7, p < 0.001), higher systolic (157 vs 151 mmHg, p = 0.001) and diastolic (86 vs 83 mmHg, p = 0.013) blood pressure and smaller infarct volume (2.4 vs 9.5 mL, p < 0.001). Performance of lacunar score was as follows: sensitivity 0.44; specificity 0.82; PPV 0.39; NPV 0.84; and accuracy 0.73. Assuming a prevalence of lacunar stroke of 13\%, PPV lowered to 0.30 but NPV was 0.90. Lacunar score performed better for supratentorial lacunar infarcts. Conclusion: Lacunar score had a very good specificity and NPV for screening of lacunar stroke. Implementation of this simple tool into clinical practice may help hyperacute management and guide patient selection in clinical trials. Data access statement: Data supporting the results of this paper are available upon reasonable request to the corresponding author.",

keywords = "acute ischemic stroke, diagnostic accuracy, early identification, emergency department, lacunar infarct, Lacunar stroke, Oxfordshire Community Stroke Project, screening",

author = "Francesco Arba and Chiara Rinaldi and M{\"a}rit Jensen and Matthias Endres and Fiebach, \{Jochen B.\} and Robin Lemmens and Muir, \{Keith W.\} and Norbert Nighoghossian and Salvador Pedraza and Simonsen, \{Claus Z.\} and Vincent Thijs and Christian Gerloff and Wardlaw, \{Joanna M.\} and G{\"o}tz Thomalla",

note = "Publisher Copyright: {\textcopyright} 2024 World Stroke Organization.",

year = "2024",

month = oct,

doi = "10.1177/17474930241253987",

language = "English",

volume = "19",

pages = "935--941",

journal = "International Journal of Stroke",

issn = "1747-4930",

publisher = "SAGE Publications Ltd",

number = "8",

}

Arba, F, Rinaldi, C, Jensen, M, Endres, M, Fiebach, JB, Lemmens, R, Muir, KW, Nighoghossian, N, Pedraza, S, Simonsen, CZ, Thijs, V, Gerloff, C, Wardlaw, JM & Thomalla, G 2024, 'Validation of a simple clinical tool for screening of acute lacunar stroke—A substudy of the WAKE-UP trial', International Journal of Stroke, bind 19, nr. 8, s. 935-941. https://doi.org/10.1177/17474930241253987

Validation of a simple clinical tool for screening of acute lacunar stroke—A substudy of the WAKE-UP trial. / Arba, Francesco; Rinaldi, Chiara; Jensen, Märit et al.
I: International Journal of Stroke, Bind 19, Nr. 8, 10.2024, s. 935-941.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

TY - JOUR

T1 - Validation of a simple clinical tool for screening of acute lacunar stroke—A substudy of the WAKE-UP trial

AU - Arba, Francesco

AU - Rinaldi, Chiara

AU - Jensen, Märit

AU - Endres, Matthias

AU - Fiebach, Jochen B.

AU - Lemmens, Robin

AU - Muir, Keith W.

AU - Nighoghossian, Norbert

AU - Pedraza, Salvador

AU - Simonsen, Claus Z.

AU - Thijs, Vincent

AU - Gerloff, Christian

AU - Wardlaw, Joanna M.

AU - Thomalla, Götz

PY - 2024/10

Y1 - 2024/10

N2 - Introduction: Lacunar stroke represents around a quarter of all ischemic strokes; however, their identification with computed tomography in the hyperacute setting is challenging. We aimed to validate a clinical score to identify lacunar stroke in the acute setting, independently, with data from the WAKE-UP trial using magnetic resonance imaging. Methods: We analyzed data from the WAKE-UP trial and extracted Oxfordshire Community Stroke Project (OCSP) classification. Lacunar score was defined by National Institutes of Health Stroke Scale (NIHSS) < 7 and OCSP lacunar syndrome. Assessment of lacunar infarct by two independent investigators was blinded to clinical data. We calculated sensitivity, specificity, negative and positive predictive value (NPV and PPV, respectively) of lacunar score. Results: We included 503 patients in the analysis, mean (±SD) age 65.2 (±11.6) years, 325 (65%) males, median (IQR) NIHSS = 6 (4–9); 108 (22%) lacunar infarcts were identified on magnetic resonance (MR), patients fulfilling lacunar score criteria were 120 (24%), of which 47 (44%) had a lacunar infarct. Lacunar score was negative in 322 (82%) of patients without lacunar infarct. Patients with lacunar score had lower NIHSS (4 vs 7, p < 0.001), higher systolic (157 vs 151 mmHg, p = 0.001) and diastolic (86 vs 83 mmHg, p = 0.013) blood pressure and smaller infarct volume (2.4 vs 9.5 mL, p < 0.001). Performance of lacunar score was as follows: sensitivity 0.44; specificity 0.82; PPV 0.39; NPV 0.84; and accuracy 0.73. Assuming a prevalence of lacunar stroke of 13%, PPV lowered to 0.30 but NPV was 0.90. Lacunar score performed better for supratentorial lacunar infarcts. Conclusion: Lacunar score had a very good specificity and NPV for screening of lacunar stroke. Implementation of this simple tool into clinical practice may help hyperacute management and guide patient selection in clinical trials. Data access statement: Data supporting the results of this paper are available upon reasonable request to the corresponding author.

AB - Introduction: Lacunar stroke represents around a quarter of all ischemic strokes; however, their identification with computed tomography in the hyperacute setting is challenging. We aimed to validate a clinical score to identify lacunar stroke in the acute setting, independently, with data from the WAKE-UP trial using magnetic resonance imaging. Methods: We analyzed data from the WAKE-UP trial and extracted Oxfordshire Community Stroke Project (OCSP) classification. Lacunar score was defined by National Institutes of Health Stroke Scale (NIHSS) < 7 and OCSP lacunar syndrome. Assessment of lacunar infarct by two independent investigators was blinded to clinical data. We calculated sensitivity, specificity, negative and positive predictive value (NPV and PPV, respectively) of lacunar score. Results: We included 503 patients in the analysis, mean (±SD) age 65.2 (±11.6) years, 325 (65%) males, median (IQR) NIHSS = 6 (4–9); 108 (22%) lacunar infarcts were identified on magnetic resonance (MR), patients fulfilling lacunar score criteria were 120 (24%), of which 47 (44%) had a lacunar infarct. Lacunar score was negative in 322 (82%) of patients without lacunar infarct. Patients with lacunar score had lower NIHSS (4 vs 7, p < 0.001), higher systolic (157 vs 151 mmHg, p = 0.001) and diastolic (86 vs 83 mmHg, p = 0.013) blood pressure and smaller infarct volume (2.4 vs 9.5 mL, p < 0.001). Performance of lacunar score was as follows: sensitivity 0.44; specificity 0.82; PPV 0.39; NPV 0.84; and accuracy 0.73. Assuming a prevalence of lacunar stroke of 13%, PPV lowered to 0.30 but NPV was 0.90. Lacunar score performed better for supratentorial lacunar infarcts. Conclusion: Lacunar score had a very good specificity and NPV for screening of lacunar stroke. Implementation of this simple tool into clinical practice may help hyperacute management and guide patient selection in clinical trials. Data access statement: Data supporting the results of this paper are available upon reasonable request to the corresponding author.

KW - acute ischemic stroke

KW - diagnostic accuracy

KW - early identification

KW - emergency department

KW - lacunar infarct

KW - Lacunar stroke

KW - Oxfordshire Community Stroke Project

KW - screening

UR - https://www.scopus.com/pages/publications/85193480897

U2 - 10.1177/17474930241253987

DO - 10.1177/17474930241253987

M3 - Journal article

C2 - 38676549

AN - SCOPUS:85193480897

SN - 1747-4930

VL - 19

SP - 935

EP - 941

JO - International Journal of Stroke

JF - International Journal of Stroke

IS - 8

ER -

Validation of a simple clinical tool for screening of acute lacunar stroke—A substudy of the WAKE-UP trial

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