Why the study?
It was unclear whether stroke severity influences rates of intracardiac thrombus, prompting investigation of an NIHSS threshold below which acute cardiac CT was unnecessary.
Does hyperacute cardiac CT identify intracardiac thrombus in patients with suspected stroke, and is there a NIHSS threshold below which it is unnecessary?
Population
314 consecutive patients with suspected stroke undergoing multimodal brain imaging and concurrent non-gated cardiac CT
Design
Prospective cohort study
Key result
A baseline NIHSS threshold of ≥ 4 identified all patients with intracardiac thrombus on hyperacute cardiac CT, yielding 100% sensitivity and 100% negative predictive value.
Authors
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NIHSS ≥4 may support selective cardiac CT in hyperacute stroke; leaves open prospective validation before practice change.
Cohort (n=314)
No
Does hyperacute cardiac CT identify intracardiac thrombus in patients with suspected stroke, and is there a NIHSS threshold below which it is unnecessary?
Absolute Event Rate: 4% vs 0%
p-value: p=0.033
Hyperacute cardiac CT can identify intracardiac thrombus in a small percentage of stroke patients, and a NIHSS threshold of ≥4 may safely stratify patients who warrant this imaging to optimize yield and reduce radiation.
Tomari et al. (2023) conducted a cohort in Hyperacute stroke (n=314). NIHSS ≥ 4 vs. NIHSS < 4 was evaluated on Intracardiac thrombus detection on hyperacute cardiac CT (p=0.033). A baseline NIHSS threshold of ≥ 4 identified all patients with intracardiac thrombus on hyperacute cardiac CT, yielding 100% sensitivity and 100% negative predictive value.