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Background: Patients with acute cerebral large-vessel occlusion (LVO) are candidates for thrombectomy. Early detection of LVO by emergent triage according to clinical symptoms is difficult. We aimed to investigate the usefulness of evaluation using the Glasgow Coma Scale (GCS) in acute stroke patients to predict possible LVO.

Methods: We retrospectively evaluated our stroke registry data from Jan. to Dec. 2015. Patients diagnosed with acute stroke in our emergency room (ER) within 6 hours of stroke onset were included. All LVO patients were documented on magnetic resonance imaging or computed tomography angiography after admission. We analyzed the relationship between GCS and LVO.

Results: Altogether, 319 acute stroke patients presenting to the ER within 6 hours of stroke onset were included and analyzed. Eighty-two (25.7%) patients had LVO and were possible candidates for thrombectomy. Patients in the LVO group were significantly older (73 ± 12 years, p < 0.05) and showed a greater incidence of atrial fibrillation (45% vs. 13%, p < 0.001) and dense artery sign on non-contrast computed tomography (61% vs. 1%, p < 0.001). The non-LVO group had a greater proportion of male patients (64% vs. 48%). GCS showed fair sensitivity (94%) and specificity (90%) in predicting LVO stroke. The positive predictive value was 77% and the negative predictive value was 98%. The odds ratio for LVO with GCS score < 15 was 60.39 (95% confidence interval: 13.32–273.83).

Conclusion: GCS evaluation at triage can help in early detection of patients with LVO stroke and may hasten the protocol of intra-arterial thrombectomy.