Predictors of false-positive stroke thrombectomy transfers

Abstract

Background Most patients with large vessel occlusion (LVO) stroke need to be transferred to receive thrombectomy. To save time, the decision to transfer often relies on clinical scales as a surrogate for LVO rather than imaging. However, clinical scales have been associated with high levels of diagnostic error. The aim of this study is to define the susceptibility to overdiagnosis of our current transfer decision process by measuring the rate of non-treatment transfers, the most common reasons for no treatment and potential predictors. Methods Clinical and transfer data on consecutive patients transferred to a single endovascular capable centre for possible thrombectomy via stroke code activation were retrospectively reviewed. Whether patients underwent the procedure, why they did not undergo the procedure, and other clinical and logistical predictors were recorded. χ 2 tests and multivariate logistic regression analysis were performed.

Real-world effects of late window neurothrombectomy: procedure rates increase without night-time bias

“…Therefore, more aggressive interventional management of patients with previously marginal indications is another possible contributor to the witnessed increase in MT incidence in this study. A study performed from 2015 to 2016 found false-positive thrombectomy transfers accounted for the majority (54%) of consultations 24. Whether the lower rate of false-positive consultations in the present study (44%) represents an increase in aggressiveness to pursue thrombectomy in the current climate is unclear.…”

CTA Protocols in a Telestroke Network Improve Efficiency for Both Spoke and Hub Hospitals

“…A primary reason patients transferred to a hub hospital for EVT do not ultimately undergo thrombectomy is that no ELVO is present despite a suggestive clinical presentation. [25][26][27] This was confirmed in our pre-CTA cohort in which one-third of patients transferred to our hub did not have an LVO. Identifying which patients do not require EVT while still at the SH represents, therefore, a potential intervention in the evolution of stroke care systems.…”

Interhospital Transfer Before Thrombectomy Is Associated With Delayed Treatment and Worse Outcome in the STRATIS Registry (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke)

“…Currently available clinical scales for use in the field have high rates of false-positive results, with <50% of suspected patients actually undergoing MT. 29 Such an influx of unnecessary emergency department admissions may create a significant burden on treatment teams. Clearly, more accurate means of rapid triage and diagnosis are needed.…”