Screening tool promising for EDs to predict acute symptomatic stroke

Bad writeup, asymptomatic is not the same as symptomatic. I think asymptomatic diagnosis would be vastly more useful to rule out mimics.

Symptomatic can mean showing symptoms, or it may concern a specific symptom. 

Asymptomatic means there are no symptoms.

Screening tool promising for EDs to predict acute symptomatic stroke

Key takeaways:

• DESTINY is a single tool intended for rapid stroke screening in emergency departments.
• The evaluation tool displayed greater sensitivity than other methods to predict acute symptomatic stroke.

A novel screening tool placed in emergency departments showed promise in detecting acute symptomatic stroke, doing so with greater sensitivity than other screening methods, according to a presentation at the International Stroke Conference.

“Screening is a valuable tool for triaging, protocol activation, and resource allocation in emergency medicine, yet no tool has been identified as superior in the prehospital and hospital setting,” Robin Novakovic-White, MD, professor of radiology and neurology at UT Southwestern Medical Center, and colleagues wrote.

New research suggests a screening tool is promising for emergency departments to predict acute asymptomatic stroke. Image: Adobe Stock

The researchers sought to test effectiveness of the Dallas ED Screening Tool to Identify Stroke (DESTINY), which was developed as a single tool to screen for all stroke subtypes within EDs.

They commenced a phase 2, prospective, two-part, adaptive design validation study of DESTINY in EDs during early triage of suspected stroke patients from May 2022 to August 2022.

DESTINY, which was incorporated into electronic health records and standardized workflow for nursing triage in ED, was used to screen 284 consecutive patients. Novakovic-White and colleagues recorded the NIH Stroke Scale (NIHSS) score at presentation, primary diagnosis and stroke subtypes for each patient.

Primary analysis outcomes included predictability of acute symptomatic stroke (PCI, LVO, and MeVO), while secondary outcomes included comparison of DESTINY performance with other screening tools. Score completion failures were retrospectively scored by a vascular neurologist who provided the chief complaint and initial exam and was blinded to final diagnosis and imaging. A total of 32% of screened patients had score completion failures.

According to results, acute symptomatic stroke occurred in 39% (n = 110) (sTIA, 20; PCI, 31; CRAO, 5; MeVO, 22; LVO, 19; hemorrhagic, 11; other, 13) of those reviewed by DESTINY. DESTINY displayed greater sensitivity to other tools to predict acute symptomatic stroke (sensitivity 0.95 [95% CI; 90.3-98.8], specificity 0.44 [95% CI: 36.9-51.6]); MeVO (sensitivity 0.91 [95% CI: 78.9-1], specificity 0.31 [95% CI: 25.3-36.5]) and performed comparably to NIHSS for predicting PCI.

“In high volume and fast-paced EDs, DESTINY has promise as single tool to identify patients with acute symptomatic stroke and [large vessel occlusion],” Novakovic-White and colleagues wrote.

Sources/Disclosures

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Source:

Novakovic-White R, et al. Comparison of Dallas ED Screening Tool to Identify Stroke (DESTINY) With Other Stroke Screening Tools. Presented at: International Stroke Conference; Feb. 7-9, 2024; Phoenix.

Disclosures: Novakovic-White reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Stroke rates higher in asymptomatic vs. symptomatic AF

Pretty much useless since nothing is presented on how to find  asymptomatic AF. Don't just describe a problem. Suggest a solution, otherwise this research is almost completely useless.
https://www.healio.com/cardiology/arrhythmia-disorders/news/online/%7B4f08a315-afbe-4605-9b90-8fbef54d60f0%7D/stroke-rates-higher-in-asymptomatic-vs-symptomatic-af?utm_source=selligent&utm_medium=email&utm_campaign=cardiology%20news&m_bt=592835816269
Previous stroke rates were higher among patients with newly diagnosed atrial fibrillation compared with those who experienced prior symptoms, according to results from the GLORIA-AF registry, presented at EHRA Europace-Cardiostim 2017.
According to the presentation from Steffen P. Christow, MD, cardiologist at Hospital Ingolstadt GmbH in Germany, AF has a significant effect on morbidity and mortality in patients because of a fivefold risk for stroke.

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“Patients with nonvalvular [AF] have a fivefold increased risk of stroke compared to those without [AF]. Strokes in patients with nonvalvular [AF] tend to be particularly severe and disabling, with about half of patients dying within 1 year,” Christow said in a press release from the European Society of Cardiology. “When patients are unaware of their [AF], they remain untreated and unprotected from stroke.”
The multinational, prospective GLORIA-AF registry enrolled 6,011 patients aged 18 years or older who were newly diagnosed with nonvalvular AF and had a high risk for stroke.
According to Christow and colleagues, the aims of the study were to investigate patient characteristics that influenced choice of antithrombotic treatment of newly diagnosed patients with nonvalvular AF at risk for stroke, describe antithrombotic treatment patterns and collect safety and efficacy data on antithrombotic treatments.
At the time of diagnosis, approximately two-thirds of the patients included in the study were asymptomatic and one-third of patients were symptomatic.
The results of the study showed that asymptomatic patients were twice as likely to have permanent AF (OR = 0.49; 95% CI, 0.4-0.59), more than twice as likely to have had a previous stroke (OR = 0.37; 95% CI, 0.3-0.46) and twice as likely to have had a previous stroke or transient ischemic attack (OR = 0.47; 95% CI, 0.4-0.56) vs. patients who were symptomatic.
Symptomatic patients were more likely to have had CAD (OR = 1.28; 95% CI, 1.1-1.48) or congestive HF (OR = 2.79; 95% CI, 2.45-3.18) than asymptomatic patients, Christow and colleagues found.
“The finding of a higher rate of previous stroke in the asymptomatic patients despite no differences in the number of stroke risk factors may be explained by a longer but undiagnosed history of [AF],” Christow said in the release. “These results underline the urgent need for public programs to detect [AF] in the general population.” – by Dave Quaile
Reference:
Christow SP, et al. Abstract 1669. Presented at: EHRA Europace – Cardiostim 2017; June 18-21, 2017; Vienna.