Abstract Details

Title The Ultimate Stroke Scale (USS): An Innovative Tool for Automated Large Vessel Occlusion Screening

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P11 - Poster Session 11 (8:00 AM-9:00 AM)

Poster/Presentation
Number 13-001

Objective

The USS aims to streamline LVO screening by utilizing multiple validated stroke scales simultaneously.

Background This study compares manual stroke scale calculations against e-calculated scores using the USS, a software designed to automate multiple large vessel occlusion (LVO) screening scales from a modified NIHSS.

Design/Methods

We prospectively applied eight stroke screening scales (NIHSS, BE-FAST, VAN, LAMS, FAST-ED, EMS RACE, 3-ISS, and PASS) to 199 stroke activations between January 2021 and December 2023. In a prospective, external validation study, the scales were later recalculated using the USS with a modified NIHSS score that included hand grip strength. A Bland-Altman analysis was conducted to assess agreement between manual and USS-calculated scores.

Results

PASS demonstrated the strongest agreement, with minimal bias (mean difference, M = -0.0402), a standard deviation (SD) of 0.315, and narrow Limits of Agreement (LoAs) (-0.657–0.576). BE-FAST and VAN also showed strong agreement, with minimal biases (M = -0.121 and M = -0.106), low SDs (0.369 and 0.367), and tight LoAs (-0.844–0.603 and -0.825–0.614). LAMS showed strong agreement with a small positive bias (M = 0.151), SD: 0.685, and LoAs: -1.19–1.49.

FAST-ED, 3-ISS, and EMS-RACE displayed moderate agreement. FAST-ED had a moderate bias (M = -0.151), SD: 0.991, and LoAs: -2.09–1.79, while 3-ISS had a moderate bias (M = -0.538), SD: 0.981, and LoAs: -2.47–1.39. EMS-RACE had a moderate bias (M = -0.387), SD: 1.43, and wider LoAs (-3.19–2.42).

NIHSS showed the weakest agreement, with the largest bias (M = -0.975), SD: 1.48, and LoAs: -3.87–1.92, reflecting expected discrepancies due to its modification.

Conclusions

The USS demonstrates strong to moderate agreement with manual methods across tested stroke scales, with minimal biases and consistent performances. With further refinement and larger studies, the USS could become a valuable tool to expedite LVO screening.

Authors/Disclosures
Sachin A. Kothari, MD PRESENTER	Dr. Kothari has nothing to disclose.
Rami Morsi, MD (University of Chicago)	Dr. Morsi has nothing to disclose.
Olivia Kozel, BA	Miss Kozel has nothing to disclose.
Harsh Desai, MD	Dr. Desai has nothing to disclose.
Archit B. Baskaran, MD (Columbus Plaza)	Dr. Baskaran has nothing to disclose.
Neha Sehgal, DO	Dr. Sehgal has nothing to disclose.
Okker Verhagen Metman, DO (University of Chicago)	Dr. Verhagen Metman has nothing to disclose.
Ahmad Chahine, MD	Dr. Chahine has nothing to disclose.
Matthew M. Smith, MD	Dr. Smith has nothing to disclose.
Elisheva R. Coleman, MD (University of Chicago Medical Center)	Dr. Coleman has nothing to disclose.
James E. Siegler III, MD (University of Chicago)	Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Siegler has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Bayer. Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Serb. Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Wallaby Phenox. Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke: Vascular and Interventional Neurology. Dr. Siegler has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for Precision Medicine, LLC. The institution of Dr. Siegler has received research support from Philips. The institution of Dr. Siegler has received research support from Medtronic.
James R. Brorson, MD (University of Chicago)	Dr. Brorson has received personal compensation in the range of $500-$4,999 for serving as a Consultant for National Peer Review Corporation. Dr. Brorson has a non-compensated relationship as a Vascular Neurology Pilot Committee with American Board of Psychiatry and Neurology that is relevant to AAN interests or activities.
Shyam Prabhakaran, MD (University of Chicago)	Dr. Prabhakaran has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for University of Cincinnati. Dr. Prabhakaran has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for University of Cincinnati. The institution of Dr. Prabhakaran has received research support from NIH . The institution of Dr. Prabhakaran has received research support from AHRQ. Dr. Prabhakaran has received publishing royalties from a publication relating to health care.
Tareq Kass-Hout, MD (Jackson Memorial Hospital)	Dr. Kass-Hout has nothing to disclose.

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