Neurology
COHORT
● Cohort
Could four simple signs help community hospitals spot the most dangerous strokes faster?
Frontiers in Medicine
Published March 30, 2026
When a stroke happens, the first hospital a patient reaches is often a smaller community one. These hospitals need a fast, reliable way to spot the most severe strokes—those caused by a large blood clot blocking a major artery in the front of the brain. These 'anterior circulation large vessel occlusion' strokes require immediate transfer to a specialized center for advanced treatment.
This research looked at data from 722 stroke patients to create a simple, four-point checklist for community hospitals. The scale, called CEA2, checks for four things: a change in consciousness, gaze deviation (where the eyes are stuck looking to one side), weakness in one arm, and whether the patient has a history of atrial fibrillation (an irregular heart rhythm).
In testing, when a patient scored 2 or more points on this scale, it was a strong predictor of this major type of stroke. The tool was also linked to identifying strokes likely caused by a clot from the heart. The goal is to give frontline doctors in community hospitals a clear, quick way to recognize which stroke patients need to be rushed to a comprehensive stroke center for life-saving procedures.
View Original Abstract ↓
ObjectiveTo develop a simple and novel scale to predict acute anterior circulation large vessel occlusion (LVO) strokes for community hospitals in China.MethodsWe conducted a retrospective analysis of a prospectively collected acute ischemic stroke patient database (STRESS registry). The patients were divided into the derivation and validation cohorts. We derived a scale in the derivation cohort and assessed the scale in the validation cohort.ResultsA total of 1,196 patients were screened for acute ischemic stroke, 722 patients were included to the study, 406 and 316 in the derivation and validation cohorts, respectively. Multivariable logistic regression analysis identified gaze deviation [odds ratio (OR): 5.66, 95% confidence interval (CI): 2.79–11.50], motor arm weakness (OR: 4.17, 95% CI: 1.17–14.87), atrial fibrillation (OR: 4.10, 95% CI: 2.12–7.90), and level of consciousness (OR: 3.76, 95% CI: 1.56–9.04) were significantly associated with acute anterior circulation large vessel occlusion stroke. Therefore, a four-item community hospitals stroke scale was developed, including consciousness, eye gaze, arm weakness, and atrial fibrillation (CEA2). In the validation cohort, the Youden index, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CEA2 ≥ 2 in predicting anterior circulation LVO strokes were 0.722, 0.878 (95% CI 0.818–0.921), 0.844 (95% CI 0.745–0.865), 0.846 (95% CI 0.755–0.871), 0.876 (95% CI 0.809–0.917), and 0.861 (95% CI 0.801–0.881), respectively. Further analysis revealed that when the CEA2 score, including atrial fibrillation, was ≥ 2, the sensitivity, specificity, and accuracy for predicting cardiogenic embolism etiology were 0.792(95% CI 0.722–0.850), 0.849 (95% CI 0.785–0.899), and 0.821 (95% CI 0.773–0.862), respectively.ConclusionThe CEA2 scale may be a simple and effective tool that identifies anterior circulation LVO strokes and provides relevant etiology information for community hospitals in China.