Optimizing in-hospital triage for large vessel occlusion using a novel clinical scale (GAI2AA)

Tsuyoshi Ohta, Ichiro Nakahara, Shoji Matsumoto, Daisuke Kondo, Sadayoshi Watanabe, Kenji Okada, Maki Fukuda, Noritaka Masahira, Takaya Tsuno, Toshiki Matsuoka, Mitsuhiro Takemura, Hitoshi Fukuda, Naoki Fukui, Tetsuya Ueba

Research output: Contribution to journalArticlepeer-review

16 Citations (Scopus)


ObjectiveTo identify a proximal anterior circulation occlusion for effectively administering immediate mechanical thrombectomy by developing a novel, simple diagnostic scale to predict the occlusion, to compare its validity with available scales, and to assess its utility.MethodsTo develop a novel clinical scale, we retrospectively analyzed a cohort of 429 patients with acute ischemic stroke from a single center. The novel scale GAI2AA was applied to a prospective cohort of 259 patients from 3 stroke centers for external validation. The utility of the scale as an in-hospital triage was compared for the temporal factors of 158 patients with the occlusion.ResultsIn a scale-developmental phase, those with a proximal anterior circulation occlusion had significantly more frequent signs of hemispheric symptoms, including gaze palsy, aphasia, inattention, arm paresis, and atrial fibrillation. The GAI2AA scale was developed using consolidated hemispheric symptoms and was scored as follows: score = 2, arm paresis score = 1, and atrial fibrillation score = 1. A cutoff value ≥3 was optimal for the correlation between sensitivity (88%) and specificity (81%), with a C statistic of 0.90 (95% confidence interval 0.87-0.93). External validation indicated that discrimination was significantly better than or not different from that of available complex scales. Door-to-puncture time was significantly reduced (91 [82-111] vs 52 [32-75] minutes, p < 0.001).ConclusionThe GAI2AA scale showed high sensitivity and specificity when an optimal cutoff score was used and was useful as an in-hospital triage tool.

Original languageEnglish
Pages (from-to)E1997-E2006
Issue number22
Publication statusPublished - 26-11-2019

All Science Journal Classification (ASJC) codes

  • Clinical Neurology


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