Portable cerebral blood flow monitor to detect large vessel occlusion in patients with suspected stroke

In conclusion, did this perform fast enough to get patients 100% recovered? That is the only goal in stroke! Why the fuck aren't you measuring that?

“What's measured, improves.” So said management legend and author Peter F. Drucker 

 Portable cerebral blood flow monitor to detect large vessel occlusion in patients with suspected stroke

1. http://orcid.org/0000-0003-0871-9549Christopher G Favilla1,
2. Grayson L Baird2,
3. Kedar Grama3,
4. Soren Konecky3,
5. Sarah Carter1,
6. Wendy Smith4,
7. Rebecca Gitlevich1,
8. Alexa Lebron-Cruz1,
9. Arjun G Yodh5,
10. Ryan A McTaggart2

1. Correspondence to Dr Christopher G Favilla, Department of Neurology, University of Pennsylvania, Philadelphia, USA; Christopher.favilla@pennmedicine.upenn.edu

Abstract

Background Early detection of large vessel occlusion (LVO) facilitates triage to an appropriate stroke center to reduce treatment times and improve outcomes. Prehospital stroke scales are not sufficiently sensitive, so we investigated the ability of the portable Openwater optical blood flow monitor to detect LVO.

Methods Patients were prospectively enrolled at two comprehensive stroke centers during stroke alert evaluation within 24 hours of onset with National Institutes of Health Stroke Scale (NIHSS) score ≥2. A 70 s bedside optical blood flow scan generated cerebral blood flow waveforms based on relative changes in speckle contrast. Anterior circulation LVO was determined by CT angiography. A deep learning model trained on all patient data using fivefold cross-validation and learned discriminative representations from the raw speckle contrast waveform data. Receiver operating characteristic (ROC) analysis compared the Openwater diagnostic performance (ie, LVO detection) with prehospital stroke scales.

Results Among 135 patients, 52 (39%) had an anterior circulation LVO. The median NIHSS score was 8 (IQR 4–14). The Openwater instrument had 79% sensitivity and 84% specificity for the detection of LVO. The rapid arterial occlusion evaluation (RACE) scale had 60% sensitivity and 81% specificity and the Los Angeles motor scale (LAMS) had 50% sensitivity and 81% specificity. The binary Openwater classification (high-likelihood vs low-likelihood) had an area under the ROC (AUROC) of 0.82 (95% CI 0.75 to 0.88), which outperformed RACE (AUC 0.70; 95% CI 0.62 to 0.78; P=0.04) and LAMS (AUC 0.65; 95% CI 0.57 to 0.73; P=0.002).

Conclusions The Openwater optical blood flow monitor outperformed prehospital stroke scales for the detection of LVO in patients undergoing acute stroke evaluation in the emergency department. These encouraging findings need to be validated in an independent test set and the prehospital environment.

Data availability statement

Data are available upon reasonable request. The de-identified data that support the reported findings are available from the corresponding author upon reasonable request.

https://doi.org/10.1136/jnis-2024-021536

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