Use of the Triage Stroke Panel in a neurologic emergency service
The American Journal of Emergency Medicine. 2009-06-01; 27(5): 558-562
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1. Am J Emerg Med. 2009 Jun;27(5):558-62. doi: 10.1016/j.ajem.2008.05.001.
Use of the Triage Stroke Panel in a neurologic emergency service.
Sibon I(1), Rouanet F, Meissner W, Orgogozo JM.
(1)Department of Clinical Neurosciences, Bordeaux University Hospital, France.
BACKGROUND: Acute stroke is associated with serum elevations of numerous markers.
We evaluated the additive accuracy of the Triage Stroke Panel (D-dimer,
B-natriuretic peptide, matrix metalloproteinase 9, and S-100beta) to the triaging
nurse for acute stroke diagnosis.
METHODS: Consecutive patients with suspected stroke were included in this
prospective, controlled, single-center study. A well-trained stroke center triage
nurse assigned a probability that the patient had experienced a stroke (certain,
very probable, probable, not likely, doubtful, or other); then, the Triage Stroke
Panel testing was performed. Patients’ diagnosis was based on clinical and
imaging data by a neurologist blinded to the test results.
RESULTS: Two hundred four patients were evaluated. Confirmed strokes and
transient ischemic attacks (TIAs) were observed in 131 patients. When considering
an experienced stroke nurse’s assessment of « other, » « doubtful, » or « not likely »
to be negative for stroke and categorizing TIA with stroke, the stroke panel’s
Multimarker Index (MMX) value had identical accuracy (approximately 70%) and
equivalent sensitivity (approximately 94%) and specificity (approximately 24%)
for stroke diagnosis to that of the nurse. Combining nurse assessment with the
MMX result significantly improved the specificity of diagnosing « mimic » vs stroke
+ TIA from 25.4% (nurse assessment only) to 46.0% (nurse assessment + MMX; P <
CONCLUSIONS: The Triage Stroke Panel provides objective information that
complements a triage nurse in the assessment of a suspected stroke patient. Its
performance compares favorably with that of a well-trained stroke center triage
nurse, suggesting potential use in nonexpert centers for improving the accuracy
of stroke diagnosis.
PMID: 19497461 [Indexed for MEDLINE]