Лос-Анджелесская шкала моторного дефицита (LAMS) как инструмент догоспитального отбора пациентов с предполагаемой окклюзией крупных церебральных артерий

Введение. Маршрутизация пациентов с окклюзией крупных церебральных артерий (ЦА) в специализированные стационары — важный организационный аспект оказания помощи больным с инсультом, способствующий улучшению клинических исходов после тромбоэкстракции (ТЭ). Клинические шкалы, такие как Лос-Анджелесская шкала моторного дефицита (LAMS), — наиболее доступные инструменты догоспитального отбора пациентов для эндоваскулярных центров, однако их эффективность требует оценки в реальных условиях.

Цель исследования — оценить диагностическую эффективность LAMS для выявления острых окклюзий крупных ЦА в условиях инсультной сети Москвы.

Материалы и методы. В исследование было включено 336 пациентов с подозрением на инсульт, оцененных врачами скорой медицинской помощи (СМП) по шкале LAMS. Наличие окклюзий подтверждалось в стационаре при помощи КТ-ангиографии. Чувствительность и специфичность шкалы оценивались при пороговых значениях LAMS 4–5 баллов; также проводился ROC-анализ. Отдельно изучались результаты ретроспективной оценки LAMS на основании первичного неврологического осмотра в стационаре.

Результаты. Чувствительность и специфичность шкалы LAMS (4–5 баллов) составили 50,47 % и 76,86 % соответственно. Показатели варьировались в зависимости от времени, прошедшего с момента появления симптомов: <2 ч. — 41,51 % и 63,53 %; 2–6 ч. — 57,14 % и 81,94 %; >6 ч. — 61,54 % и 87,50 %. При ретроспективной оценке на основе первичного неврологического осмотра чувствительность составила 72,90 %, специфичность — 77,73 %. ROC-анализ подтвердил более высокую прогностическую ценность ретроспективной оценки (AUC = 0,80; 95 % ДИ — 0,75–0,85) по сравнению с догоспитальной (AUC = 0,67; 95 % ДИ — 0,61–0,73).

Заключение. Шкала LAMS позволяет выявлять пациентов с высоким риском окклюзии крупных ЦА, однако ее точность в первые 2 ч. заболевания ограничена. Низкая чувствительность на этом отрезке времени требует корректировки алгоритмов маршрутизации. Различия в диагностической эффективности между догоспитальной и ретроспективной стационарной оценками могут свидетельствовать о целесообразности проведения обучающих программ для врачей СМП.

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