Preprint: Please note that this article has not completed peer review.
Research article

Designing a novel pre-hospital treatment decision model based on transcranial ultrasound and clinical assessment for patients with suspected acute stroke: exploratory study

Daria Antipova, Leila Eadie, Helen Shannon, Philip Wilson, Ashish Macaden
DOI: 10.21203/rs.2.11831/v1

Abstract

Background and objectives

Earlier initiation of reperfusion therapy for patients with acute ischaemic stroke is associated with better outcomes. The current exploratory study presents a planned interim analysis aiming to validate a theoretical treatment decision model to select subjects who could benefit from early thrombolysis and/or direct transfer for mechanical thrombectomy.

Methods

Consecutive subjects suspected of having suffered a stroke within the last 72 hours were recruited. Transcranial grey-scale and Doppler ultrasonography was performed within 24 hours of brain computed tomography. The National Institutes of Health Stroke score (NIHSS), modified Rankin Score and medical history were collected retrospectively. Hospital discharge diagnosis was used as the gold standard. Comparative analyses were performed to identify variables that could assist in designing the treatment decision model. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were calculated.

Results

Among a total number of 50 recruited patients, 27 had a final diagnosis of ischaemic stroke, including 10 cases with large vessel occlusion (LVO). Stroke patients were more likely to be older (p=0.03) and to have NIHSS total score ≥9 (p=0.021). NIHSS ≥4 (p=0.032), atrial fibrillation (p=0.033) and cortical signs (p=0.005) were significant indicators of LVO.

The proposed model based on grey-scale/Doppler findings and clinical assessment showed 77% sensitivity and 92% specificity (77% PPV, 92% NPV) for making a decision to initiate reperfusion therapy. Ultrasound findings improved the performance of a model based on clinical data alone (50% sensitivity, 89% specificity, 64% PPV, 82% NPV).

Subjects with a stroke mimicking condition were more likely to have been given reperfusion therapy inappropriately using this model, but no subjects with haemorrhage would have received intravenous thrombolysis. Insufficient acoustic window was seen in approximately 40% of included participants.

Conclusions

The proposed treatment decision model might potentially be used for selecting subjects with ischaemic stroke who would benefit from early initiation of reperfusion therapy or immediate transfer for endovascular intervention. A larger sample is required to establish performance of the model with an acceptable degree of precision.

Keywords
stroke; large vessel occlusion; TCD; transcranial ultrasonography; thrombectomy

Figures

Background

Methods

Results

Discussion

Conclusions

List of Abbreviations

Declarations

Additional Materials

References

Supplementary Files

STATUS: In Review

Comments: 0
PDF Downloads: 0
HTML Views: 21

Integrity Check:

Peer Review Timeline

Version 1

Posted 23 Jul, 2019

  • No community comments so far
  • Review #3 received

    Received 02 Aug, 2019

  • Editorial decision: Major revision

    On 02 Aug, 2019

  • Review #2 received

    Received 28 Jul, 2019

  • Reviewer #4 agreed

    On 25 Jul, 2019

  • Review #1 received

    Received 23 Jul, 2019

  • Reviewer #3 agreed

    On 20 Jul, 2019

  • Reviewer #2 agreed

    On 20 Jul, 2019

  • 5 reviewer(s) invited

    Invitations sent on 19 Jul, 2019

  • Reviewer #1 agreed

    On 19 Jul, 2019

  • Submission checks complete

    On 17 Jul, 2019

  • Editor assigned

    On 03 Jul, 2019

  • Editor invited

    On 02 Jul, 2019

  • First submitted

    On 02 Jul, 2019

More from BMC Neurology

Comments (0)

Comments can take the form of short reviews, notes or questions to the author. Comments will be posted immediately, but removed and moderated if flagged.

Learn more about our company.

Preprint: Please note that this article has not completed peer review.
Research article

Designing a novel pre-hospital treatment decision model based on transcranial ultrasound and clinical assessment for patients with suspected acute stroke: exploratory study

Daria Antipova, Leila Eadie, Helen Shannon, Philip Wilson, Ashish Macaden

STATUS: In Review

Comments: 0
PDF Downloads: 0
HTML Views: 21

Integrity Check:

  • Article

  • Peer Review Timeline

  • Related Articles

  • Comments

Abstract

Background and objectives

Earlier initiation of reperfusion therapy for patients with acute ischaemic stroke is associated with better outcomes. The current exploratory study presents a planned interim analysis aiming to validate a theoretical treatment decision model to select subjects who could benefit from early thrombolysis and/or direct transfer for mechanical thrombectomy.

Methods

Consecutive subjects suspected of having suffered a stroke within the last 72 hours were recruited. Transcranial grey-scale and Doppler ultrasonography was performed within 24 hours of brain computed tomography. The National Institutes of Health Stroke score (NIHSS), modified Rankin Score and medical history were collected retrospectively. Hospital discharge diagnosis was used as the gold standard. Comparative analyses were performed to identify variables that could assist in designing the treatment decision model. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were calculated.

Results

Among a total number of 50 recruited patients, 27 had a final diagnosis of ischaemic stroke, including 10 cases with large vessel occlusion (LVO). Stroke patients were more likely to be older (p=0.03) and to have NIHSS total score ≥9 (p=0.021). NIHSS ≥4 (p=0.032), atrial fibrillation (p=0.033) and cortical signs (p=0.005) were significant indicators of LVO.

The proposed model based on grey-scale/Doppler findings and clinical assessment showed 77% sensitivity and 92% specificity (77% PPV, 92% NPV) for making a decision to initiate reperfusion therapy. Ultrasound findings improved the performance of a model based on clinical data alone (50% sensitivity, 89% specificity, 64% PPV, 82% NPV).

Subjects with a stroke mimicking condition were more likely to have been given reperfusion therapy inappropriately using this model, but no subjects with haemorrhage would have received intravenous thrombolysis. Insufficient acoustic window was seen in approximately 40% of included participants.

Conclusions

The proposed treatment decision model might potentially be used for selecting subjects with ischaemic stroke who would benefit from early initiation of reperfusion therapy or immediate transfer for endovascular intervention. A larger sample is required to establish performance of the model with an acceptable degree of precision.

Figures

Background

Methods

Results

Discussion

Conclusions

List of Abbreviations

Declarations

Additional Materials

References

Learn more about our company.