Automated emergent large vessel occlusion detection by artificial intelligence improves stroke workflow in a hub and spoke stroke system of care

Flawed research. No measurement of 100% recovery. Until we get survivors in charge most stroke research will fail to be useful and what is needed.

 Automated emergent large vessel occlusion detection by artificial intelligence improves stroke workflow in a hub and spoke stroke system of care

1. http://orcid.org/0000-0003-1979-2848Lucas Elijovich1,2,
2. http://orcid.org/0000-0002-0039-0016David Dornbos III2,
3. Christopher Nickele2,
4. Andrei Alexandrov1,
5. Violiza Inoa-Acosta1,2,
6. http://orcid.org/0000-0002-1536-1613Adam S Arthur2,
7. Daniel Hoit2

1. Correspondence to Dr Lucas Elijovich, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN 38120, USA; lelijovich@semmes-murphey.com

Abstract

Background Emergent large vessel occlusion (ELVO) acute ischemic stroke is a time-sensitive disease.

Objective To describe our experience with artificial intelligence (AI) for automated ELVO detection and its impact on stroke workflow.

Methods We conducted a retrospective chart review of code stroke cases in which VizAI was used for automated ELVO detection. Patients with ELVO identified by VizAI were compared with patients with ELVO identified by usual care. Details of treatment, CT angiography (CTA) interpretation by blinded neuroradiologists, and stroke workflow metrics were collected. Univariate statistical comparisons and linear regression analysis were performed to quantify time savings for stroke metrics.

Results Six hundred and eighty consecutive code strokes were evaluated by AI; 104 patients were diagnosed with ELVO during the study period. Forty-five patients with ELVO were identified by AI and 59 by usual care. Sixty-nine mechanical thrombectomies were performed.

Median time from CTA to team notification was shorter for AI ELVOs (7 vs 26 min; p<0.001). Door to arterial puncture was faster for transfer patients with ELVO detected by AI versus usual care transfer patients (141 vs 185 min; p=0.027). AI yielded a time savings of 22 min for team notification and a 23 min reduction in door to arterial puncture for transfer patients.(But you don't even know how fast this has to be to get to 100% recovery. Without that knowledge you don't even know what goal to shoot for.)

Conclusions AI automated alerts can be incorporated into a comprehensive stroke center hub and spoke system of care. The use of AI to detect ELVO improves clinically meaningful stroke workflow metrics, resulting in faster treatment times for mechanical thrombectomy.

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

http://dx.doi.org/10.1136/neurintsurg-2021-017714

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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