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]