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

@article{rodriguezpardo2026revalidation,
  title = {{Revalidation of the M-DIRECT scale in prehospital identification of acute stroke patients for endovascular treatment.}},
  author = {Jorge Rodríguez-Pardo and Nicolás Riera-López and Anitza Lorente-Moro and Elena de Celis-Ruiz and Rocío Alonso-Castillo and Andrea Higuera and Manuel Lorenzo and Carlos Gómez-Escalonilla and Carlos Estebas-Armas and Carlos Hervás-Testal and Ricardo Rigual and Laura Casado-Fernández and Laura González-Martín and Gerardo Ruiz-Ares and Exuperio Díez-Tejedor and Patricia Calleja-Castaño and Joaquín Carneado-Ruiz and José Fernández-Ferro and Andrés García-Pastor and Araceli García-Torres and Antonio Cruz-Culebras and Álvaro Ximénez-Carrillo and Pilar Sobrino-García and Beatriz Oyanguren-Rodeño and Eduardo Escolar-Escamilla and Laura Izquierdo-Esteban and Blanca Fuentes and María Alonso de Leciñana and Madrid Stroke Network},
  journal = {BMC emergency medicine},
  year = {2026},
  month = aug,
  doi = {10.1186/s12873-026-01711-8},
  url = {https://europepmc.org/article/MED/42972247},
  note = {CC BY-NC-ND},
}

TY  - JOUR
TI  - Revalidation of the M-DIRECT scale in prehospital identification of acute stroke patients for endovascular treatment.
AU  - Jorge Rodríguez-Pardo
AU  - Nicolás Riera-López
AU  - Anitza Lorente-Moro
AU  - Elena de Celis-Ruiz
AU  - Rocío Alonso-Castillo
AU  - Andrea Higuera
AU  - Manuel Lorenzo
AU  - Carlos Gómez-Escalonilla
AU  - Carlos Estebas-Armas
AU  - Carlos Hervás-Testal
AU  - Ricardo Rigual
AU  - Laura Casado-Fernández
AU  - Laura González-Martín
AU  - Gerardo Ruiz-Ares
AU  - Exuperio Díez-Tejedor
AU  - Patricia Calleja-Castaño
AU  - Joaquín Carneado-Ruiz
AU  - José Fernández-Ferro
AU  - Andrés García-Pastor
AU  - Araceli García-Torres
AU  - Antonio Cruz-Culebras
AU  - Álvaro Ximénez-Carrillo
AU  - Pilar Sobrino-García
AU  - Beatriz Oyanguren-Rodeño
AU  - Eduardo Escolar-Escamilla
AU  - Laura Izquierdo-Esteban
AU  - Blanca Fuentes
AU  - María Alonso de Leciñana
AU  - Madrid Stroke Network
PY  - 2026
DA  - 2026/08/04
JO  - BMC emergency medicine
DO  - 10.1186/s12873-026-01711-8
UR  - https://europepmc.org/article/MED/42972247
AB  - 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.
SN  - 1471-227X
ER  -