Predictors of false-positive stroke thrombectomy transfers
Predictors of false-positive stroke thrombectomy transfers
复制标题
中风血栓切除术转移假阳性的预测因素
DOI：
10.1136/neurintsurg-2017-013043
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发表时间：
2017
影响因子：
4.8
通讯作者：
Michael Chen
中科院分区：
文献类型：
--
作者：
J. Yi;D. Zielinski;B. Ouyang;J. Conners;R. Dafer;Michael Chen
背景大血管闭塞（LVO）卒中患者大多需要转院接受血栓切除术。为了节省时间，转移的决定通常依赖于临床规模作为LVO的替代品，而不是成像。然而，临床量表与高水平的诊断错误相关。本研究的目的是通过测量非治疗转移率、最常见的不治疗原因和潜在的预测因素来确定我们当前转移决策过程中过度诊断的敏感性。方法回顾性分析了转移到单个血管内治疗中心的连续患者的临床和转移数据，以通过卒中代码激活进行可能的血栓切除术。记录患者是否接受了手术，为什么他们没有接受手术，以及其他临床和后勤预测因素。进行χ2检验和多因素Logistic回归分析。结果从2015年至2016年，105/192例（54%）转移患者未接受血栓切除术，最常见的原因是转移后CTA上未发现LVO（71/104（68%））。14/16例（88%）美国国立卫生研究院卒中量表（NIHSS）评分<10分的患者未接受血栓切除术，而41/78例（52%）NIHSS评分>20分的患者接受了血栓切除术（p<0.001）。使用直升机与未治疗相关（p=0.004），而5小时内到达与治疗相关（p<0.001）。 结论临床量表似乎过度诊断了LVO，可能是我们大多数卒中代码转移未行血栓切除术的原因。因此，初级卒中中心有理由发展在转移前快速获取和解释疑似LVO患者CTA的能力。这些努力可以降低与不必要的血栓切除术转移相关的成本。
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. χ2 tests and multivariate logistic regression analysis were performed. Results From 2015 to 2016, 105/192 transferred patients (54%) did not undergo thrombectomy and the most common reason was absence of a LVO found on CTA after transfer (71/104 (68%)). 14/16 (88%) with a National Institutes of Health Stroke Scale (NIHSS) score <10 did not undergo thrombectomy while 41/78 (52%) with a NIHSS>20 underwent thrombectomy (p<0.001). Helicopter use was associated with no treatment (p=0.004) while arrival within 5 hours was associated with treatment (p<0.001). Conclusions Clinical scales appear to overdiagnose LVO and may be responsible for the majority of our stroke code transfers not undergoing thrombectomy. Primary stroke centres therefore have reason to develop the capability to rapidly acquire and interpret a CTA in patients with suspected LVO prior to transfer. Such efforts may reduce the costs associated with unnecessary thrombectomy transfers.