The Neurological Examination Improves Cranial Accelerometry Large Vessel Occlusion Prediction Accuracy
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ORIGINAL WORK
The Neurological Examination Improves Cranial Accelerometry Large Vessel Occlusion Prediction Accuracy Kevin J. Keenan1,2* , Paul A. Lovoi2 and Wade S. Smith2 © 2020 Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society
Abstract Background/Objective: We combined cranial accelerometry, a device-based approach to large vessel occlusion (LVO) prediction, with neurological examination findings to determine if this improves diagnostic accuracy compared to either alone. Methods: Cranial accelerometry recordings and NIHSS scores were obtained during stroke codes and thrombectomy transfers at an academic medical center using convenience sampling. The reference standard was discharge diagnosis of LVO stroke. We compared accuracy statistics between machine learning models trained using cranial accelerometry alone, with asymmetric arm weakness added, with NIHSS scores added, and retrospective examination only LVO prediction scales. An exploratory analysis required asymmetric arm weakness prior to model training or scale testing. Results: Of 68 patients, there were 23 LVO strokes. Cranial accelerometry was 65% sensitive (95% CI 43–84%) and 87% specific (95% CI 73–95%). Adding asymmetric arm weakness increased specificity to 91% (95% CI 79–98%). Adding asymmetric arm weakness and the NIHSS increased sensitivity to 74% (95% CI 52–90%) and decreased specificity to 89% (95% CI 76–96%). LVO prediction scales had wide sensitivity and specificity ranges. The exploratory analysis improved sensitivity to 91% (95% CI 72–99%) and specificity to 93% (95% CI 92–99%) with only three false positives and two false negatives. Conclusions: Cranial accelerometry models are improved by various additions of asymmetric arm weakness and the NIHSS. An exploratory analysis requiring asymmetric arm weakness prior to cranial accelerometry model training minimized false positives and negatives. Keywords: Diagnostic technique, Neurological, Medical device, Stroke, Intracranial thrombosis, Thrombectomy, Computed tomography angiography, Arteries Introduction Endovascular therapy (EVT) for large vessel occlusion (LVO) stroke dramatically reduces stroke-related disability, and shorter times between onset and treatment are associated with better outcomes [1–3]. Prehospital *Correspondence: [email protected] 1 Department of Neurology, University of California, Davis, 4860 Y Street, Suite 3700, Sacramento, CA 95817, USA Full list of author information is available at the end of the article
suspected stroke patients are often brought to the nearest stroke center for vascular imaging. If the hospital cannot perform EVT, precious time is lost transferring LVO stroke patients to an EVT capable center. This has led to the development of neurological examination-based scales and devices intended to predict which prehospital suspected stroke patients are suffering from LVO stroke so that they can be triaged directly to EVT capable hospitals [4].
Neurological examination-based LVO stroke prediction scal
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