Telestroke Assessment With Perfusion CT Improves the Diagnostic Accuracy of Stroke vs. Mimic

Background and Purpose: CT perfusion (CTP) has been implemented widely in regional areas of Australia for telestroke assessment. The aim of this study was to determine if, as part of telestroke assessment, CTP provided added benefit to clinical features in distinguishing between strokes and mimic an...

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Autores principales:	Lucinda Tran, Longting Lin, Neil Spratt, Andrew Bivard, Beng Lim Alvin Chew, James W. Evans, William O'Brien, Christopher Levi, Timothy Ang, Khaled Alanati, Elizabeth Pepper, Carlos Garcia-Esperon, Mark Parsons
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	stroke telestroke imaging—computed tomography transient ischaemic attack (TIA) CT perfusion (CTP) stroke mimic Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/f495e52d797e42e8bab842a9e987ec15
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spelling	oai:doaj.org-article:f495e52d797e42e8bab842a9e987ec152021-12-03T16:45:54ZTelestroke Assessment With Perfusion CT Improves the Diagnostic Accuracy of Stroke vs. Mimic1664-229510.3389/fneur.2021.745673https://doaj.org/article/f495e52d797e42e8bab842a9e987ec152021-12-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fneur.2021.745673/fullhttps://doaj.org/toc/1664-2295Background and Purpose: CT perfusion (CTP) has been implemented widely in regional areas of Australia for telestroke assessment. The aim of this study was to determine if, as part of telestroke assessment, CTP provided added benefit to clinical features in distinguishing between strokes and mimic and between transient ischaemic attack (TIA) and mimic.Methods: We retrospectively analysed 1,513 consecutively recruited patients referred to the Northern New South Wales Telestroke service, where CTP is performed as a part of telestroke assessment. Patients were classified based on the final diagnosis of stroke, TIA, or mimic. Multivariate regression models were used to determine factors that could be used to differentiate between stroke and mimic and between TIA and mimic.Results: There were 693 strokes, 97 TIA, and 259 mimics included in the multivariate regression models. For the stroke vs. mimic model using symptoms only, the area under the curve (AUC) on the receiver operator curve (ROC) was 0.71 (95% CI 0.67–0.75). For the stroke vs. mimic model using the absence of ischaemic lesion on CTP in addition to clinical features, the AUC was 0.90 (95% CI 0.88–0.92). The multivariate regression model for predicting mimic from TIA using symptoms produced an AUC of 0.71 (95% CI 0.65–0.76). The addition of absence of an ischaemic lesion on CTP to clinical features for the TIA vs. mimic model had an AUC of 0.78 (95% CI 0.73–0.83)Conclusions: In the telehealth setting, the absence of an ischaemic lesion on CTP adds to the diagnostic accuracy in distinguishing mimic from stroke, above that from clinical features.Lucinda TranLucinda TranLongting LinNeil SprattNeil SprattNeil SprattAndrew BivardBeng Lim Alvin ChewJames W. EvansWilliam O'BrienChristopher LeviTimothy AngTimothy AngKhaled AlanatiElizabeth PepperCarlos Garcia-EsperonMark ParsonsMark ParsonsMark ParsonsFrontiers Media S.A.articlestroketelestrokeimaging—computed tomographytransient ischaemic attack (TIA)CT perfusion (CTP)stroke mimicNeurology. Diseases of the nervous systemRC346-429ENFrontiers in Neurology, Vol 12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	stroke telestroke imaging—computed tomography transient ischaemic attack (TIA) CT perfusion (CTP) stroke mimic Neurology. Diseases of the nervous system RC346-429
spellingShingle	stroke telestroke imaging—computed tomography transient ischaemic attack (TIA) CT perfusion (CTP) stroke mimic Neurology. Diseases of the nervous system RC346-429 Lucinda Tran Lucinda Tran Longting Lin Neil Spratt Neil Spratt Neil Spratt Andrew Bivard Beng Lim Alvin Chew James W. Evans William O'Brien Christopher Levi Timothy Ang Timothy Ang Khaled Alanati Elizabeth Pepper Carlos Garcia-Esperon Mark Parsons Mark Parsons Mark Parsons Telestroke Assessment With Perfusion CT Improves the Diagnostic Accuracy of Stroke vs. Mimic
description	Background and Purpose: CT perfusion (CTP) has been implemented widely in regional areas of Australia for telestroke assessment. The aim of this study was to determine if, as part of telestroke assessment, CTP provided added benefit to clinical features in distinguishing between strokes and mimic and between transient ischaemic attack (TIA) and mimic.Methods: We retrospectively analysed 1,513 consecutively recruited patients referred to the Northern New South Wales Telestroke service, where CTP is performed as a part of telestroke assessment. Patients were classified based on the final diagnosis of stroke, TIA, or mimic. Multivariate regression models were used to determine factors that could be used to differentiate between stroke and mimic and between TIA and mimic.Results: There were 693 strokes, 97 TIA, and 259 mimics included in the multivariate regression models. For the stroke vs. mimic model using symptoms only, the area under the curve (AUC) on the receiver operator curve (ROC) was 0.71 (95% CI 0.67–0.75). For the stroke vs. mimic model using the absence of ischaemic lesion on CTP in addition to clinical features, the AUC was 0.90 (95% CI 0.88–0.92). The multivariate regression model for predicting mimic from TIA using symptoms produced an AUC of 0.71 (95% CI 0.65–0.76). The addition of absence of an ischaemic lesion on CTP to clinical features for the TIA vs. mimic model had an AUC of 0.78 (95% CI 0.73–0.83)Conclusions: In the telehealth setting, the absence of an ischaemic lesion on CTP adds to the diagnostic accuracy in distinguishing mimic from stroke, above that from clinical features.
format	article
author	Lucinda Tran Lucinda Tran Longting Lin Neil Spratt Neil Spratt Neil Spratt Andrew Bivard Beng Lim Alvin Chew James W. Evans William O'Brien Christopher Levi Timothy Ang Timothy Ang Khaled Alanati Elizabeth Pepper Carlos Garcia-Esperon Mark Parsons Mark Parsons Mark Parsons
author_facet	Lucinda Tran Lucinda Tran Longting Lin Neil Spratt Neil Spratt Neil Spratt Andrew Bivard Beng Lim Alvin Chew James W. Evans William O'Brien Christopher Levi Timothy Ang Timothy Ang Khaled Alanati Elizabeth Pepper Carlos Garcia-Esperon Mark Parsons Mark Parsons Mark Parsons
author_sort	Lucinda Tran
title	Telestroke Assessment With Perfusion CT Improves the Diagnostic Accuracy of Stroke vs. Mimic
title_short	Telestroke Assessment With Perfusion CT Improves the Diagnostic Accuracy of Stroke vs. Mimic
title_full	Telestroke Assessment With Perfusion CT Improves the Diagnostic Accuracy of Stroke vs. Mimic
title_fullStr	Telestroke Assessment With Perfusion CT Improves the Diagnostic Accuracy of Stroke vs. Mimic
title_full_unstemmed	Telestroke Assessment With Perfusion CT Improves the Diagnostic Accuracy of Stroke vs. Mimic
title_sort	telestroke assessment with perfusion ct improves the diagnostic accuracy of stroke vs. mimic
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/f495e52d797e42e8bab842a9e987ec15
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Telestroke Assessment With Perfusion CT Improves the Diagnostic Accuracy of Stroke vs. Mimic

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