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Background and purpose <p>The M-DIRECT scale was implemented for prehospital triage of acute stroke, such that patients with an M-DIRECT score ≥ 2 are transferred directly to an endovascular treatment (EVT)-ready center (EVT-C) instead of a nearer stroke unit (SU). Our aim is to evaluate the performance of M-DIRECT at five years post-implementation.</p> Methods <p>A prospective observational study of consecutive prehospital code stroke patients attended by regional emergency medical services during 2022 in an urban network of 6.75&#xa0;million inhabitants. Basal characteristics, time metrics, presence of large or medium vessel occlusion (LVO/MeVO), and treatments were compared between EVT-C and non-EVT-ready SU groups according to the M-DIRECT score.</p> Results <p>A total of 1950 patients were included. Of these, 992 (51%) were first attended at an EVT-C and 958 at a nearer SU (49%). Furthermore, 706 (36%) patients were M-DIRECT positive, of which 413 (58%) had an LVO/MeVO, and 354 (50%) underwent EVT. Of 1244&#xa0;M-DIRECT negative patients, 204 (16%) had an LVO/MeVO and 105 (8%) underwent EVT. M-DIRECT showed 77% sensitivity, 76% specificity, and 77% diagnostic accuracy for EVT from prehospital triage, with an AUC (95% CI) of 0.768 (0.742–0.793). A positive M-DIRECT score was independently associated with EVT adjusted for age, sex, NIHSS, and unknown onset, with aOR (95% CI) 3.05 (1.65–5.68), and consistently across every arterial segment. Only 46 out of 459 (10%) EVT required a secondary transfer.</p> Conclusions <p>M-DIRECT scale accurately identifies EVT candidates prehospital, reduces secondary transfers, and independently predicts EVT likelihood across different vessel occlusions.</p>

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Revalidation of the M-DIRECT scale in prehospital identification of acute stroke patients for endovascular treatment

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月4日

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  • Jorge Rodríguez-Pardo,
  • Nicolás Riera-López,
  • Anitza Lorente-Moro,
  • Elena de Celis-Ruiz,
  • Rocío Alonso-Castillo,
  • Andrea Higuera,
  • Manuel Lorenzo,
  • Carlos Gómez-Escalonilla,
  • Carlos Estebas-Armas,
  • Carlos Hervás-Testal,
  • Ricardo Rigual,
  • Laura Casado-Fernández,
  • Laura González-Martín,
  • Gerardo Ruiz-Ares,
  • Exuperio Díez-Tejedor,
  • Patricia Calleja-Castaño,
  • Joaquín Carneado-Ruiz,
  • José Fernández-Ferro,
  • Andrés García-Pastor,
  • Araceli García-Torres,
  • Antonio Cruz-Culebras,
  • Álvaro Ximénez-Carrillo,
  • Pilar Sobrino-García,
  • Beatriz Oyanguren-Rodeño,
  • Eduardo Escolar-Escamilla,
  • Laura Izquierdo-Esteban,
  • Blanca Fuentes,
  • María Alonso de Leciñana

摘要

Background and purpose

The M-DIRECT scale was implemented for prehospital triage of acute stroke, such that patients with an M-DIRECT score ≥ 2 are transferred directly to an endovascular treatment (EVT)-ready center (EVT-C) instead of a nearer stroke unit (SU). Our aim is to evaluate the performance of M-DIRECT at five years post-implementation.

Methods

A prospective observational study of consecutive prehospital code stroke patients attended by regional emergency medical services during 2022 in an urban network of 6.75 million inhabitants. Basal characteristics, time metrics, presence of large or medium vessel occlusion (LVO/MeVO), and treatments were compared between EVT-C and non-EVT-ready SU groups according to the M-DIRECT score.

Results

A total of 1950 patients were included. Of these, 992 (51%) were first attended at an EVT-C and 958 at a nearer SU (49%). Furthermore, 706 (36%) patients were M-DIRECT positive, of which 413 (58%) had an LVO/MeVO, and 354 (50%) underwent EVT. Of 1244 M-DIRECT negative patients, 204 (16%) had an LVO/MeVO and 105 (8%) underwent EVT. M-DIRECT showed 77% sensitivity, 76% specificity, and 77% diagnostic accuracy for EVT from prehospital triage, with an AUC (95% CI) of 0.768 (0.742–0.793). A positive M-DIRECT score was independently associated with EVT adjusted for age, sex, NIHSS, and unknown onset, with aOR (95% CI) 3.05 (1.65–5.68), and consistently across every arterial segment. Only 46 out of 459 (10%) EVT required a secondary transfer.

Conclusions

M-DIRECT scale accurately identifies EVT candidates prehospital, reduces secondary transfers, and independently predicts EVT likelihood across different vessel occlusions.