{
  "abstract": "Background Unlike the RACE score for large vessel occlusions, prehospital triaging of hemorrhagic stroke remains underexplored. Existing tools are either too complex or inconsistently validated. We aimed to develop a simplified clinical tool for identification of hemorrhagic stroke by the EMS in the field.Methods We retrospectively evaluated 119 patients with hemorrhagic stroke presenting between 01JAN2023 and 31DEC2023, paired with randomly selected 119 ischemic strokes. Differentiating variables were identified using univariate analysis ( table 1). A weighted scoring model was derived using beta-coefficients from multivariate regression. Diagnostic performance was evaluated across different thresholds using sensitivity , specificity, PPV, NPV, and accuracy.Results Hemorrhagic stroke was associated with younger age, higher SBP, lower GCS, and higher rates of headache, seizure, and nausea/vomiting. Independent predictors included age ≤60 years, SBP ≥180 mmHg, GCS ≤14, and headache. Seizure (p=0.056) and nausea/vomiting (p=0.59) were not significantly different when adjusting for other variables but were included in the scoring model due to potential multicollinearity. An 11-points scoring system is presented in table 2. At cut-off of 2, the score demonstrated 82.4% sensitivity, 66.4% specificity, 71% PPV, 79% NPV and 74.4% accuracy. Diagnostic performance at different cut-offs is presented in table 3 and figure 1.Conclusion The HEAD-FIRST score (Headache, Hypertension, Emesis, Age, Decreased consciousness, Seizure) is a simplified clinical tool for rapid field and bedside triaging of hemorrhagic stroke. Prospective EMS-based studies are warranted for real-world validation and establishment of ideal score cut-off value.Disclosures Z. Tariq: None. A. Chaudhari: None. D. Ramirez-Abreu: None. Y. Ashouri: None. O. Zaidat: None.Abstract E-120 Table 1Univariate regressionVariableHemorrhagic stroke (N=119)Ischemic stroke (N=119)p-valueAge, median (IQR)66 (55-75)71 (63-79)0.005GCS, median (IQR)15 (8-15)15 (15-15)<0.001Initial SBP. median (IQR)169 (142-201)158 (143-176)0.023Initial DBP, median (IQR)93 (78-112)91 (77-105)0.148Nausea/Vomiting, n (%)39 (32.8%)17 (14.3%)0.001Seizure, n (%)15 (12.6%)4 (3.4%)0.017Headache, n (%)43 (36.1%)17 (14.3%)<0.001Abstract E-120 Table 2The HEAD-FIRST score (range 0-11)VariableScoreHeadache2Hypertension: Initial SBP 180-199 mmHg1Initial SBP ≥200 mmHg2Emesis (Nausea/Vomiting)1Age ≤ 60 years1Decreased Consciousness: GCS 12-141GCS 9-112GCS ≤ 84Seizure1Abstract E-120 Table 3Diagnostic performance at different cut-offsCutoffSensitivity (%)Specificity (%)PPV (%)NPV (%)Accuracy≥190.839.560.081.065.1≥282.466.471.079.074.4≥364.786.682.871.075.6≥446.293.387.363.469.7≥531.997.592.758.964.7≥621.099.296.255.760.1≥713.4100.0100.053.656.7Abstract E-120 Figure 1ROC curve and diagnostic threshold plot",
  "authors": [
    {
      "affiliations": [
        "Neurointervention, Mercy Health - St. Vincent Medical Center, Toledo, OH"
      ],
      "name": "Z Tariq"
    },
    {
      "affiliations": [
        "Neurointervention, Mercy Health - St. Vincent Medical Center, Toledo, OH"
      ],
      "name": "A Chaudhari"
    },
    {
      "affiliations": [
        "Neurointervention, Mercy Health - St. Vincent Medical Center, Toledo, OH"
      ],
      "name": "D Ramirez-Abreu"
    },
    {
      "affiliations": [
        "Neurointervention, Mercy Health - St. Vincent Medical Center, Toledo, OH"
      ],
      "name": "Y Ashouri"
    },
    {
      "affiliations": [
        "Neurointervention, Mercy Health - St. Vincent Medical Center, Toledo, OH"
      ],
      "name": "O Zaidat"
    }
  ],
  "title": "E-120 The HEAD-FIRST score: introducing the future of pre-hospital triaging in hemorrhagic stroke",
  "uid": "11a6ea4b-e8b0-51cd-9567-957fc30cdceb"
}