Abstract Details

Title Enhancing Stroke Care: Neurology Residents' Clinical Prediction of Large Vessel Occlusions for Faster Endovascular Activation

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P2 - Poster Session 2 (11:45 AM-12:45 PM)

Poster/Presentation
Number 5-019

Objective To evaluate the capability of neurology residents in predicting the presence large vessel occlusion (LVO) in acute ischemic stroke based on the initial clinical assessments.

Background LVOs are responsible for a significant portion of acute ischemic strokes, requiring quick recognition to expedite endovascular team activation and reduce treatment time. Although several clinical LVO scales have been developed for use by Emergency Medical Services (EMS), they have limited reliability and are not widely adopted for pre-activation of endovascular teams.

Design/Methods A prospective observational study at University Hospital involved evaluating all stroke codes initiated by the Emergency Department (ED) or EMS. Neurology residents conducted initial assessments, including patient history, physical examination, and NIH Stroke Scale (NIHSS) evaluations. Based on symptom onset, severity, cortical signs, and NIHSS scores, patients were categorized into four groups: A) probable LVO and stroke, B) possible LVO and stroke, C) probable stroke without LVO, and D) probable stroke mimic. All assessments were completed before CT scanning.

Results Over ten months, neurology residents assessed 159 stroke codes, identifying 27 LVO cases and 132 non-LVO cases. In the probable stroke group, residents showed a sensitivity of 48%, specificity of 96%, a positive predictive value (PPV) of 72%, and a NPV of 90%. When combining probable and possible stroke groups, the residents identified 34 patients with a sensitivity of 74%, specificity of 89%, a PPV of 5%, and an NPV of 94%. Seven LVO cases were misclassified. Among these, five patients had low NIHSS scores, two had posterior circulation LVO, and one developed an in-stent thrombus.

Conclusions

Clinical prediction of LVO by neurology residents demonstrates promise, with a PPV exceeding 70%. This approach can facilitate the prompt activation of endovascular teams, potentially improving acute stroke care. However, further validation through larger studies is necessary to enhance patient outcomes and treatment timelines in acute ischemic strokes.

Authors/Disclosures
Keyvan Heshmati, MD PRESENTER	Dr. Heshmati has nothing to disclose.
Maria Andreina Hernandez, MD	Dr. Hernandez has nothing to disclose.
Jai G. Shahani, MD	Mr. Shahani has nothing to disclose.
Priyank Khandelwal, MD	Dr. Khandelwal has nothing to disclose.
Volodymyr Vulkanov, MD (Rutgers, The State University of New Jersey)	Dr. Vulkanov has nothing to disclose.
Sushanth R. Aroor, MD	Dr. Aroor has stock in Gravity.

��ɫ��

��ɫ��