Comparative diagnostic and predictive performance of different scoring scales for identifying anterior circulation large vessel occlusion stroke

doi:10.3877/cma.j.issn.1673-9248.2026.04.005

Abstract

Abstract:

Objective

To compare the diagnostic and predictive performance of different clinical scales for anterior circulation large vessel occlusion (LVO) stroke.

Methods

Patients with acute ischemic stroke admitted to Beijing Tsinghua Changgung Hospital between March 2021 and January 2024 within 24 hours of onset were prospectively enrolled. Clinical data and neurological function scores were collected, including the National Institutes of Health stroke scale (NIHSS), field assessment stroke triage for emergency destination (FAST-ED), rapid arterial occlusion evaluation (RACE), Cincinnati prehospital stroke severity scale (CPSSS), and emergency medical stroke assessment (EMSA). All patients underwent vascular imaging and were categorized based on infarct lesions and occluded vessels. The diagnostic and predictive performance of each scale for detecting new-onset LVO stroke, especially anterior circulation LVO stroke, was analyzed using receiver operating characteristic (ROC) curves.

Results

A total of 735 patients were enrolled, including 167 with new-onset LVO and 568 with non-LVO strokes. Among new-onset LVO stroke patients, 137 had anterior circulation LVO and 30 had posterior circulation LVO. For new-onset LVO stroke, the areas under the ROC curve (AUC) of FAST-ED, RACE, CPSSS, and EMSA were 0.821, 0.795, 0.778, and 0.776, respectively. For anterior circulation LVO stroke, the corresponding AUCs were 0.844, 0.836, 0.806, and 0.806, respectively. FAST-ED and RACE showed superior predictive performance for anterior circulation LVO stroke compared with CPSSS and EMSA. A FAST-ED score ≥2 yielded optimal diagnostic performance for anterior circulation LVO stroke, with a specificity of 81.4% and a sensitivity of 80.3%. A RACE score ≥3 also showed favorable performance, with a specificity of 85.5% and a sensitivity of 70.3%.

Conclusion

FAST-ED and RACE can accurately identify new-onset anterior circulation LVO stroke, which is helpful for the early prehospital triage of anterior circulation LVO stroke patients.

Key words: Acute ischemic stroke, Large vessel occlusion, Diagnostic prediction, Scales

Chenming Wei, Jingyu Mu, Xinyi Zhao, Le Chen, Jian Wu. Comparative diagnostic and predictive performance of different scoring scales for identifying anterior circulation large vessel occlusion stroke[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2026, 20(04): 380-388.

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URL: https://zhnxgbzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1673-9248.2026.04.005

https://zhnxgbzz.cma-cmc.com.cn/EN/Y2026/V20/I04/380

Figures/Tables 8

项目	非新发LVO组（n=568）	新发LVO组（n=167）	统计值	P值
男性[例（%）]	382（67.25）	100（59.88）	χ²=3.108	0.079
年龄（岁， $x ¯$ ±s）	65.53±11.79	69.52±14.11	t=-3.308	0.001
BMI（kg/m²， $x ¯$ ±s）	25.53±3.70	24.53±3.47	t=2.520	0.012
发病到入院时间[h，M（Q₁，Q₃）]	5.00（2.00，12.00）	3.00（1.08，8.04）	Z=-3.106	0.002
入院时心率（次/分， $x ¯$ ±s）	81.52±14.76	81.70±18.51	t=0.003	0.894
入院时收缩压（mmHg， $x ¯$ ±s）	159.76±24.94	156.16±26.67	t=1.612	0.107
入院时舒张压（mmHg， $x ¯$ ±s）	87.05±16.67	85.59±17.97	t=0.980	0.327
既往史[例（%）]
脑梗死/TIA	161（28.35）	53（31.74）	χ²=0.719	0.438
出血性脑卒中	20（3.52）	8（4.79）	χ²=0.567	0.490
高血压	414（72.89）	111（66.47）	χ²=2.670	0.119
糖尿病	224（39.44）	54（32.34）	χ²=2.767	0.103
血脂异常	173（30.46）	43（25.75）	χ²=1.379	0.248
心房颤动/心房扑动/瓣膜病	52（9.15）	58（34.73）	χ²=66.333	＜0.001
冠心病	83（14.61）	34（20.36）	χ²=3.184	0.091
肿瘤	19（3.35）	16（9.58）	χ²=11.065	0.003
慢性肾病	19（3.35）	10（5.99）	χ²=2.379	0.171
神经功能评分[分，M（Q₁，Q₃）]
NIHSS评分	2（1，4）	11（5，16）	Z=-12.973	＜0.001
FAST-ED评分	0（0，1）	3（1，5）	Z=-13.431	＜0.001
RACE评分	0（0，1）	5（1，6）	Z=-12.187	＜0.001
CPSSS评分	0（0，0）	2（0，3）	Z=-13.573	＜0.001
EMSA评分	2（0，3）	4（3，5）	Z=-11.012	＜0.001

项目	非新发LVO组（n=568）	新发LVO组（n=167）	统计值	P值
男性[例（%）]	382（67.25）	100（59.88）	χ²=3.108	0.079
年龄（岁， $x ¯$ ±s）	65.53±11.79	69.52±14.11	t=-3.308	0.001
BMI（kg/m²， $x ¯$ ±s）	25.53±3.70	24.53±3.47	t=2.520	0.012
发病到入院时间[h，M（Q₁，Q₃）]	5.00（2.00，12.00）	3.00（1.08，8.04）	Z=-3.106	0.002
入院时心率（次/分， $x ¯$ ±s）	81.52±14.76	81.70±18.51	t=0.003	0.894
入院时收缩压（mmHg， $x ¯$ ±s）	159.76±24.94	156.16±26.67	t=1.612	0.107
入院时舒张压（mmHg， $x ¯$ ±s）	87.05±16.67	85.59±17.97	t=0.980	0.327
既往史[例（%）]
脑梗死/TIA	161（28.35）	53（31.74）	χ²=0.719	0.438
出血性脑卒中	20（3.52）	8（4.79）	χ²=0.567	0.490
高血压	414（72.89）	111（66.47）	χ²=2.670	0.119
糖尿病	224（39.44）	54（32.34）	χ²=2.767	0.103
血脂异常	173（30.46）	43（25.75）	χ²=1.379	0.248
心房颤动/心房扑动/瓣膜病	52（9.15）	58（34.73）	χ²=66.333	＜0.001
冠心病	83（14.61）	34（20.36）	χ²=3.184	0.091
肿瘤	19（3.35）	16（9.58）	χ²=11.065	0.003
慢性肾病	19（3.35）	10（5.99）	χ²=2.379	0.171
神经功能评分[分，M（Q₁，Q₃）]
NIHSS评分	2（1，4）	11（5，16）	Z=-12.973	＜0.001
FAST-ED评分	0（0，1）	3（1，5）	Z=-13.431	＜0.001
RACE评分	0（0，1）	5（1，6）	Z=-12.187	＜0.001
CPSSS评分	0（0，0）	2（0，3）	Z=-13.573	＜0.001
EMSA评分	2（0，3）	4（3，5）	Z=-11.012	＜0.001

	前循环组（n=137）	后循环组（n=30）	统计值	P值
男性[例（%）]	75（54.74）	25（83.33）	χ²=8.373	0.004
年龄（岁， $x ¯$ ±s）	70.54±14.39	64.87±11.93	t=2.012	0.046
BMI（kg/m²， $x ¯$ ±s）	24.16±3.39	26.13±3.42	t=-2.329	0.022
发病到入院时间[h，M（Q₁，Q₃）]	3.00（1.00，7.00）	4.91（1.98，14.00）	Z=-2.118	0.034
入院时心率（次/分， $x ¯$ ±s）	81.38±19.02	83.17±16.15	t=-0.478	0.633
入院时收缩压（mmHg， $x ¯$ ±s）	156.11±27.22	156.40±24.46	t=-0.054	0.957
入院时舒张压（mmHg， $x ¯$ ±s）	84.50±18.15	90.57±16.50	t=-1.685	0.094
既往史[例（%）]
脑梗死/TIA	43（31.39）	10（33.33）	χ²=0.043	0.831
出血性脑卒中	7（5.11）	1（3.33）	χ²=0.170	＞0.999
高血压	91（66.42）	20（66.67）	χ²=0.001	＞0.999
糖尿病	40（29.20）	14（46.67）	χ²=3.433	0.084
血脂异常	35（25.55）	8（26.67）	χ²=0.016	＞0.999
心房颤动/心房扑动/瓣膜病	51（37.23）	7（23.33）	χ²=2.096	0.204
冠心病	29（21.17）	5（16.67）	χ²=0.308	0.803
肿瘤	11（8.03）	5（16.67）	χ²=2.120	0.170
慢性肾病	9（6.57）	1（3.33）	χ²=0.458	0.692
神经功能评分[分，M（Q₁，Q₃）]
NIHSS评分	12（6，16）	5（2，9）	Z=-3.512	＜0.001
FAST-ED评分	4（2，5）	1（0，3）	Z=-3.683	＜0.001
RACE评分	5（2，6）	1（0，4）	Z=-3.974	＜0.001
CPSSS评分	2（0，3）	0（0，2）	Z=-3.488	＜0.001
EMSA评分	5（3，6）	3（0，4）	Z=-3.855	＜0.001
病灶表现[例（%）]
大面积脑梗死	79（57.66）	10（33.33）	χ²=5.853	0.025
脑组织水肿	74（54.01）	10（33.33）	χ²=4.211	0.046
出血转化	14（10.22）	3（10.00）	χ²=0.001	＞0.999

	前循环组（n=137）	后循环组（n=30）	统计值	P值
男性[例（%）]	75（54.74）	25（83.33）	χ²=8.373	0.004
年龄（岁， $x ¯$ ±s）	70.54±14.39	64.87±11.93	t=2.012	0.046
BMI（kg/m²， $x ¯$ ±s）	24.16±3.39	26.13±3.42	t=-2.329	0.022
发病到入院时间[h，M（Q₁，Q₃）]	3.00（1.00，7.00）	4.91（1.98，14.00）	Z=-2.118	0.034
入院时心率（次/分， $x ¯$ ±s）	81.38±19.02	83.17±16.15	t=-0.478	0.633
入院时收缩压（mmHg， $x ¯$ ±s）	156.11±27.22	156.40±24.46	t=-0.054	0.957
入院时舒张压（mmHg， $x ¯$ ±s）	84.50±18.15	90.57±16.50	t=-1.685	0.094
既往史[例（%）]
脑梗死/TIA	43（31.39）	10（33.33）	χ²=0.043	0.831
出血性脑卒中	7（5.11）	1（3.33）	χ²=0.170	＞0.999
高血压	91（66.42）	20（66.67）	χ²=0.001	＞0.999
糖尿病	40（29.20）	14（46.67）	χ²=3.433	0.084
血脂异常	35（25.55）	8（26.67）	χ²=0.016	＞0.999
心房颤动/心房扑动/瓣膜病	51（37.23）	7（23.33）	χ²=2.096	0.204
冠心病	29（21.17）	5（16.67）	χ²=0.308	0.803
肿瘤	11（8.03）	5（16.67）	χ²=2.120	0.170
慢性肾病	9（6.57）	1（3.33）	χ²=0.458	0.692
神经功能评分[分，M（Q₁，Q₃）]
NIHSS评分	12（6，16）	5（2，9）	Z=-3.512	＜0.001
FAST-ED评分	4（2，5）	1（0，3）	Z=-3.683	＜0.001
RACE评分	5（2，6）	1（0，4）	Z=-3.974	＜0.001
CPSSS评分	2（0，3）	0（0，2）	Z=-3.488	＜0.001
EMSA评分	5（3，6）	3（0，4）	Z=-3.855	＜0.001
病灶表现[例（%）]
大面积脑梗死	79（57.66）	10（33.33）	χ²=5.853	0.025
脑组织水肿	74（54.01）	10（33.33）	χ²=4.211	0.046
出血转化	14（10.22）	3（10.00）	χ²=0.001	＞0.999

量表	AUC	P值	95%CI	约登指数最大值	最佳截断值	敏感度（%）	特异度（%）
FAST-ED	0.821	＜0.001	0.780~0.861	0.557	2	73.1	82.6
RACE	0.795	＜0.001	0.752~0.838	0.499	3	63.5	86.4
CPSSS	0.778	＜0.001	0.732~0.824	0.492	1	67.7	81.5
EMSA	0.776	＜0.001	0.733~0.819	0.484	4	68.3	80.1

量表	Z值	AUC差异	P值	95%CI
FAST-ED vs RACE	2.142	0.026	0.032	0.002~0.049
FAST-ED vs CPSSS	3.099	0.043	0.002	0.016~0.070
FAST-ED vs EMSA	3.963	0.045	＜0.001	0.023~0.067
RACE vs CPSSS	1.325	0.017	0.185	-0.008~0.042
RACE vs EMSA	1.451	0.019	0.147	-0.007~0.044
CPSSS vs EMSA	0.120	0.002	0.904	-0.031~0.035

量表	AUC	P值	95%CI	约登指数最大值	最佳截断值	敏感度（%）	特异度（%）
FAST-ED	0.844	＜0.001	0.802~0.886	0.617	2	80.3	81.4
RACE	0.836	＜0.001	0.795~0.876	0.555	3	70.1	85.5
CPSSS	0.806	＜0.001	0.759~0.854	0.542	1	73.7	80.4
EMSA	0.806	＜0.001	0.763~0.849	0.535	4	74.5	79.1
NIHSS	0.849	＜0.001	0.810~0.889	0.599	7	74.5	85.5

量表	Z值	AUC差异	P值	95%CI
FAST-ED vs RACE	0.720	0.008	0.472	-0.015~0.031
FAST-ED vs CPSSS	2.663	0.038	0.008	0.010~0.065
FAST-ED vs EMSA	3.087	0.038	0.002	0.014~0.062
RACE vs CPSSS	2.210	0.029	0.027	0.003~0.055
RACE vs EMSA	2.415	0.029	0.016	0.006~0.053
CPSSS vs EMSA	0.017	0.987	＜0.001	-0.032~0.032
NIHSS vs FAST-ED	0.632	0.005	0.527	-0.011~0.022
NIHSS vs RACE	1.448	0.014	0.148	0.005~0.032

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