Key result
The presence of head and/or gaze deviation alone served as a reliable biomarker for large vessel occlusion with a sensitivity of 0.66 and specificity of 0.92 in patients with suspected acute stroke.
Why the study?
Reliable biomarkers of large vessel occlusions are critically necessary in telemedicine to identify the need for in-hospital mechanical thrombectomy.
Does the presence of head and/or gaze deviation reliably identify large vessel occlusion and the need for mechanical thrombectomy in patients with suspected acute stroke evaluated via telemedicine?
Cohort (n=160)
Yes
Does the presence of head and/or gaze deviation reliably identify large vessel occlusion and the need for mechanical thrombectomy in patients with suspected acute stroke evaluated via telemedicine?
Effect estimate: Sensitivity 0.66, Specificity 0.92
Head and/or gaze deviation is a highly specific and easily assessed telemedicine biomarker for identifying large vessel occlusion and the need for mechanical thrombectomy in suspected stroke patients.
BACKGROUND: Telemedicine has rapidly emerged as an important tool in emergency neurology. In particular, reliable biomarkers of large vessel occlusions (LVOs) are critically necessary in order to identify the need for in-hospital mechanical thrombectomy (MT). Based on pathophysiological factors, we propose that the presence of head and/or gaze deviation alone signifies cortical hypoperfusion and is therefore a highly sensitive marker for the presence of LVO. METHODS: We retrospectively analyzed a cohort of 160 patients, examined via telemedicine and suspected to have had an acute stroke; this included patients with ischemic or hemorrhagic stroke, transient ischemic attack, and stroke mimics. An assessment of head and gaze deviation and NIHSS score evaluation was performed. In a second analysis, patients who only had ischemia in the anterior circulation (n = 110) were evaluated. RESULTS: Head and/or gaze deviation alone was found to be a reliable marker of LVO (sensitivity: 0.66/specificity: 0.92), as well as a sound indicator for MT (0.82/0.91), in patients with suspected ischemic stroke. The performance of this indicator further improved when patients with ischemia in the anterior circulation only were assessed (LVO: 0.70/0.93; MT: 0.86/0.90). In both analyses, head and/or gaze deviation served as a better indicator for LVO or MT compared to the prevalence of motor deficits or aphasia. Of note, in patients who had ischemia in the anterior circulation, head and/or gaze deviation performed better than the NIHSS score as an indicator for MT. CONCLUSION: These findings confirm that the presence of head and/or gaze deviation serves as a reliable biomarker in stroke-based telemedicine for the diagnosis of LVO, as well as a strong indicator for MT. Furthermore, this marker is just as reliable as the NIHSS score but easier to assess. We therefore suggest that any stroke patient who displays head and/or gaze deviation should immediately be scheduled for vessel imaging and subsequently transported to a MT-competent center.
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Schröter et al. (2023) conducted a cohort in Suspected acute stroke (n=160). Head and/or gaze deviation vs. Absence of head and/or gaze deviation was evaluated on Diagnosis of large vessel occlusion (LVO) (Sensitivity 0.66, Specificity 0.92). The presence of head and/or gaze deviation alone served as a reliable biomarker for large vessel occlusion with a sensitivity of 0.66 and specificity of 0.92 in patients with suspected acute stroke.