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Stroke & neuro
M-DIRECT stroke triage scale revalidated
Revalidation of the M-DIRECT scale in prehospital identification of acute stroke patients for endovascular treatment
BMC Emergency Medicine · 2026-08-04 · Added 4 November 2026
A Spanish prospective study of 1,950 prehospital code-stroke patients revalidated the M-DIRECT scale five years after implementation, showing 77% sensitivity and 76% specificity for identifying endovascular-treatment candidates, with a positive score more than tripling the odds of EVT.
- Study type
- Cohort
- Design
- Prospective observational cohort
- Participants
- 1,950 prehospital code-stroke patients, urban network of 6.75 million
- Main finding
- Sensitivity 77%, specificity 76%, AUC 0.768 for EVT; 58% of M-DIRECT-positive patients had LVO/MeVO and 50% underwent EVT; positive score independently associated with EVT (aOR 3.05, 95% CI 1.65–5.68); only 10% of EVT patients needed a secondary transfer
- Caveat
- Scale is embedded in a Spanish regional system with physician involvement, and only about a third of screened patients were M-DIRECT-positive
- Bottom line
- Hypothesis-generating
Why it matters in Australia (Medium relevance). Stroke destination decisions are everyday paramedic work here, but M-DIRECT isn't used on Australian roads and Spain runs a physician-dispatch model the scale was built into.
Learning goal
Weigh the benefits and risks of using a prehospital stroke triage scale to route patients directly for endovascular treatment.
More
- Topic: Stroke & neuro
- Daily scan: 4 November 2026
- Podcast: Paramedic Papers Daily, 4 November 2026
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