You will need to find out how your hospital uses such a system to relegate you to a treatment protocol. This will be needed to be done in advance since if you are locked in and the lockedin protocol leads to minimal
supportive treatment you are screwed. You can't allow the medical staff to determine this.
http://www.frontiersin.org/Journal/10.3389/fneur.2013.00140/full?utm_source=newsletter&utm_medium=email&utm_campaign=Neurology-w46-2013
- 1Center of Functionally Integrative Neuroscience and MINDLab, Aarhus University, Aarhus, Denmark
- 2Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- 3Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- 4Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
MRI is widely used in the assessment of acute ischemic stroke. In
particular, it identifies the mismatch between hypoperfused and the
permanently damaged tissue, the PWI-DWI mismatch volume. It is used to
help triage patients into active or supportive treatment pathways.
COMBAT Stroke is an automated software tool for estimating the mismatch
volume and ratio based on MRI. Herein, we validate the decision made by
the software with actual clinical decision rendered. Furthermore, we
evaluate the association between treatment decisions (both automated and
actual) and outcomes. COMBAT Stroke was used to determine PWI-DWI
mismatch volume and ratio in 228 patients from two European multi-center
stroke databases. We performed confusion matrix analysis to summarize
the agreement between the automated selection and the clinical decision.
Finally, we evaluated the clinical and imaging outcomes of the patients
in the four entries of the confusion matrix (true positive, true
negative, false negative, and false positive). About 186 of 228 patients
with acute stroke underwent thrombolytic treatment,
with the remaining
42 receiving supportive treatment only. Selection based on radiographic
criteria using COMBAT Stroke classified 142 patients as potential
candidates for thrombolytic treatment and 86 for supportive treatment;
60% sensitivity and 29% specificity. The patients deemed eligible for
thrombolytic treatment by COMBAT Stroke demonstrated significantly
higher rates of compromised tissue salvage, less neurological deficit,
and were more likely to experience thrombus dissolving and
reestablishment of normal blood flow at 24 h follow-up compared to those
who were treated without substantial PWI-DWI mismatch. These results
provide evidence that COMBAT Stroke, in addition to clinical assessment,
may offer an optimal framework for a fast, efficient, and standardized
clinical support tool to select patients for thrombolysis in acute
ischemic stroke. (Once again proving that tPA is truly a goldilocks question)
More at link.
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