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C de Andrade JB, Quinn TJ, Carbonera LA, Montanaro VVA, Robles AC, Pádua Gomes R, Ribeiro S, Sampaio Silva G. An automated flowchart for the Modified Rankin Scale assessment: A multicenter inter-rater agreement analysis. Int J Stroke 2024:17474930241246157. [PMID: 38546172 DOI: 10.1177/17474930241246157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
BACKGROUND AND OBJECTIVE The Modified Rankin Scale (mRS) is a widely adopted scale for assessing stroke recovery. Despite limitations, the mRS has been adopted as primary outcome in most recent clinical acute stroke trials. Designed to be used by multidisciplinary clinical staff, the congruency of this scale is not consistent, which may lead to mistakes in clinical or research application. We aimed to develop and validate an interactive and automated digital tool for assessing the mRS-the iRankin. METHODS A panel of five board-certified and mRS-trained vascular neurologists developed an automated flowchart based on current mRS literature. Two international experts were consulted on content and provided feedback on the prototype platform. The platform contained five vignettes and five real video cases, representing mRS grades 0-5. For validation, we invited neurological staff from six comprehensive stroke centers to complete an online assessment. Participants were randomized into two equal groups usual practice versus iRankin. The participants were randomly allocated in pairs for the congruency analysis. Weighted kappa (kw) and proportions were used to describe agreement. RESULTS A total of 59 professionals completed the assessment. The kw was dramatically improved among nurses, 0.76 (95% confidence interval (CI) = 0.55-0.97) × 0.30 (0.07-0.67), and among vascular neurologists, 0.87 (0.72-1) × 0.82 (0.66-0.98). In the accuracy analysis, after the standard mRS values for the vignettes and videos were determined by a panel of experts, and considering each correct answer as equivalent to 1 point on a scale of 0-15, it revealed a higher mean of 10.6 (±2.2) in the iRankin group and 8.2 (±2.3) points in the control group (p = 0.02). In an adjusted analysis, the iRankin adoption was independently associated with the score of congruencies between reported and standard scores (beta coefficient = 2.22, 95% CI = 0.64-3.81, p = 0.007). CONCLUSION The iRankin adoption led to a substantial or near-perfect agreement in all analyzed professional categories. More trials are needed to generalize our findings. Our user-friendly and free platform is available at https://www.irankinscale.com/.
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Affiliation(s)
- Joao Brainer C de Andrade
- Departments of Health Informatics and Neurology, Universidade Federal de São Paulo, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Bioengineering Laboratory, Aeronautics Institute of Technology (ITA), São Jose dos Campos, Brazil
- Centro Universitário São Camilo, São Paulo, Brazil
| | | | | | | | | | | | | | - Gisele Sampaio Silva
- Departments of Health Informatics and Neurology, Universidade Federal de São Paulo, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
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Santos ACFDF, Coelho LLS, Caldas GDC, Araújo LC, Gagliardi VDB, Carbonera LA. General anesthesia versus conscious sedation in mechanical thrombectomy for patients with acute ischemic stroke: systematic review and meta-analysis. Arq Neuropsiquiatr 2024; 82:1-7. [PMID: 38608712 PMCID: PMC11014755 DOI: 10.1055/s-0044-1785693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/25/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND After recently published randomized clinical trials, the choice of the best anesthetic procedure for mechanical thrombectomy (MT) in acute ischemic stroke (AIS) due to large vessel occlusion (LVO) is not definite. OBJECTIVE To compare the efficacy and safety of general anesthesia (GA) versus conscious sedation (CS) in patients with AIS who underwent MT, explicitly focusing on procedural and clinical outcomes and the incidence of adverse events. METHODS PubMed, Embase, and Cochrane were systematically searched for randomized controlled trials (RCTs) comparing GA versus CS in patients who underwent MT due to LVO-AIS. Odds ratios (ORs) were calculated for binary outcomes, with 95% confidence intervals (CIs). Random effects models were used for all outcomes. Heterogeneity was assessed with I2 statistics. RESULTS Eight RCTs (1,300 patients) were included, of whom 650 (50%) underwent GA. Recanalization success was significantly higher in the GA group (OR 1.68; 95% CI 1.26-2.24; p < 0.04) than in CS. No significant difference between groups were found for good functional recovery (OR 1.13; IC 95% 0.76-1.67; p = 0.56), incidence of pneumonia (OR 1.23; IC 95% 0.56- 2,69; p = 0.61), three-month mortality (OR 0.99; IC 95% 0.73-1.34; p = 0.95), or cerebral hemorrhage (OR 0.97; IC 95% 0.68-1.38; p = 0.88). CONCLUSION Despite the increase in recanalization success rates in the GA group, GA and CS show similar rates of good functional recovery, three-month mortality, incidence of pneumonia, and cerebral hemorrhage in patients undergoing MT.
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Carbonera LA, Rivillas JA, Gordon Perue G, da Luz Dorneles L, Boiani M, de Souza AC, Sampaio Silva G, Dorn M, Martins SCO. The MAPSTROKE project: A computational strategy to improve access to acute stroke care. Int J Stroke 2024:17474930241234528. [PMID: 38346937 DOI: 10.1177/17474930241234528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Global access to acute stroke treatment is variable worldwide, with notable gaps in low and middle-income countries (LMIC), especially in rural areas. Ensuring a standardized method for pinpointing the existing regional coverage and proposing potential sites for new stroke centers is essential to change this scenario. AIMS To create and apply computational strategies (CSs) to determine optimal locations for new acute stroke centers (ASCs), with a pilot application in nine Latin American regions/countries. METHODS Hospitals treating acute ischemic stroke (AIS) with intravenous thrombolysis (IVT) and meeting the minimum infrastructure requirements per structured protocols were categorized as ASCs. Hospitals with emergency departments, noncontrast computed tomography (NCCT) scanners, and 24/7 laboratories were identified as potential acute stroke centers (PASCs). Hospital geolocation data were collected and mapped using the OpenStreetMap data set. A 45-min drive radius was considered the ideal coverage area for each hospital based on the drive speeds from the OpenRouteService database. Population data, including demographic density, were obtained from the Kontur Population data sets. The proposed CS assessed the population covered by ASCs and proposed new ASCs or artificial points (APs) settled in densely populated areas to achieve a target population coverage (TPC) of 95%. RESULTS The observed coverage in the region presented significant disparities, ranging from 0% in the Bahamas to 73.92% in Trinidad and Tobago. No country/region reached the 95% TPC using only its current ASCs or PASCs, leading to the proposal of APs. For example, in Rio Grande do Sul, Brazil, the introduction of 132 new centers was suggested. Furthermore, it was observed that most ASCs were in major urban hubs or university hospitals, leaving rural areas largely underserved. CONCLUSIONS The MAPSTROKE project has the potential to provide a systematic approach to identify areas with limited access to stroke centers and propose solutions for increasing access to AIS treatment. DATA ACCESS STATEMENT Data used for this publication are available from the authors upon reasonable request.
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Affiliation(s)
| | - Julián Alejandro Rivillas
- Department of Neurology, Fundación Valle del Lili Hospital Universitario, Cali, Colombia
- Public Health Department, Universidad Icesi, Cali, Colombia
| | - Gillian Gordon Perue
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Leonardo da Luz Dorneles
- Institute of Informatics and Center for Biotechnology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Mateus Boiani
- Institute of Informatics and Center for Biotechnology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Ana Cláudia de Souza
- Department of Neurology and Neurosurgery, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Gisele Sampaio Silva
- Department of Neurology, Universidade Federal de São Paulo (UNIFESP) and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marcio Dorn
- Institute of Informatics and Center for Biotechnology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Sheila Cristina Ouriques Martins
- Department of Neurology and Neurosurgery, Hospital Moinhos de Vento, Porto Alegre, Brazil
- Department of Internal Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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Silva GS, Alves MM, Barros FCD, Frudit ME, Pontes-Neto OM, Mont'Alverne FJ, Rebello LC, Carbonera LA, Abud DG, Lima F, de Souza AC, Liebeskind D, Mosmann G, Bezerra D, Saver J, Cardoso F, Nogueira RG, Martins SO. The role of intravenous thrombolysis before mechanical Thrombectomy: A subgroup analysis of the RESILIENT trial. J Neurol Sci 2024; 457:122853. [PMID: 38182456 DOI: 10.1016/j.jns.2023.122853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/20/2023] [Accepted: 12/17/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Randomized trials have recently evaluated the non-inferiority of direct thrombectomy versus intravenous thrombolysis (IVT) followed by endovascular therapy in anterior circulation large vessel occlusion (LVO) stroke in patients eligible for IVT within 4.5 h from stroke onset with controversial results. We aimed to assess the effect of IVT on the clinical outcome of mechanical thrombectomy (MT) in the RESILIENT trial. METHODS RESILIENT was a randomized, prospective, multicenter, controlled trial assessing the safety and efficacy of thrombectomy versus medical treatment alone. A total of 221 patients were enrolled. The trial showed a substantial benefit of MT when added to medical management. All eligible patients received intravenous tPA within the 4.5-h-window. Ordinal logistic and binary regression analyses using intravenous tPA as an interaction term were performed with adjustments for potential confounders, including age, baseline NIHSS score, occlusion site, and ASPECTS. A p-value <0.05 was considered statistically significant. RESULTS Among 221 randomized patients (median NIHSS, 18 IQR [14-21]), 155 (70%) were treated with IVT. There was no difference in the mRS ordinal shift and frequency of functional independence between patients who received or not IV tPA; the odds ratio for the ordinal mRS shift was 2.63 [1.48-4.69] for the IVT group and 1.54 [0.63-3.74] for the no IVT group, with a p-value of 0.42. IVT also did not affect the frequency of good recanalization (TICI 2b or higher) and hemorrhagic transformation. CONCLUSIONS The large effect size of MT on LVO outcomes was not significantly affected by IVT. TRIAL REGISTRATION RESILIENT ClinicalTrials.gov number, NCT02216643.
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Affiliation(s)
- Gisele Sampaio Silva
- Universidade Federal de São Paulo, São Paulo, Brazil; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | | | | | | | | | | | | | | | - Daniel Giansante Abud
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | | | | | | | | | | | - Jeffrey Saver
- Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
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Martins SCO, Pontes-Neto OM, Pille A, Secchi TL, Miranda Alves MAD, Rebello LC, Oliveira-Filho J, Lange MC, de Freitas GR, de Andrade JBC, Rocha LJDA, Bezerra DDC, Souza ACD, Carbonera LA, Nogueira RG, Silva GS. Reperfusion therapy for acute ischemic stroke: where are we in 2023? Arq Neuropsiquiatr 2023; 81:1030-1039. [PMID: 38157871 PMCID: PMC10756810 DOI: 10.1055/s-0043-1777721] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/21/2023] [Indexed: 01/03/2024]
Abstract
Over the last three decades, stroke care has undergone significant transformations mainly driven by the introduction of reperfusion therapy and the organization of systems of care. Patients receiving treatment through a well-structured stroke service have a much higher chance of favorable outcomes, thereby decreasing both disability and mortality. In this article, we reviewed the scientific evidence for stroke reperfusion therapy, including thrombolysis and thrombectomy, and its implementation in the public health system in Brazil.
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Affiliation(s)
- Sheila Cristina Ouriques Martins
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre RS, Brazil.
- Hospital Moinhos de Vento, Porto Alegre RS, Brazil.
| | | | - Arthur Pille
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre RS, Brazil.
- Hospital Moinhos de Vento, Porto Alegre RS, Brazil.
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Klu M, de Souza AC, Carbonera LA, Secchi TL, Pille A, Rodrigues M, Brondani R, de Almeida AG, Dal Pizzol A, Camelo DMF, Mantovani GP, Oldoni C, Tessari MS, Nasi LA, Martins SCO. Improving door-to-reperfusion time in acute ischemic stroke during the COVID-19 pandemic: experience from a public comprehensive stroke center in Brazil. Front Neurol 2023; 14:1155931. [PMID: 37492852 PMCID: PMC10365273 DOI: 10.3389/fneur.2023.1155931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/13/2023] [Indexed: 07/27/2023] Open
Abstract
Background The global COVID-19 pandemic has had a devastating effect on global health, resulting in a strain on healthcare services worldwide. The faster a patient with acute ischemic stroke (AIS) receives reperfusion treatment, the greater the odds of a good functional outcome. To maintain the time-dependent processes in acute stroke care, strategies to reorganize infrastructure and optimize human and medical resources were needed. Methods Data from AIS patients who received thrombolytic therapy were prospectively assessed in the emergency department (ED) of Hospital de Clínicas de Porto Alegre from 2019 to 2021. Treatment times for each stage were measured, and the reasons for a delay in receiving thrombolytic therapy were evaluated. Results A total of 256 patients received thrombolytic therapy during this period. Patients who arrived by the emergency medical service (EMS) had a lower median door-to-needle time (DNT). In the multivariable analysis, the independent predictors of DNT >60 min were previous atrial fibrillation (OR 7) and receiving thrombolysis in the ED (OR 9). The majority of patients had more than one reason for treatment delay. The main reasons were as follows: delay in starting the CT scan, delay in the decision-making process after the CT scan, and delay in reducing blood pressure. Several actions were implemented during the study period. The most important factor that contributed to a decrease in DNT was starting the bolus and continuous infusion of tPA on the CT scan table (decreased the median DNT from 74 to 52, DNT ≤ 60 min in 67% of patients treated at radiology service vs. 24% of patients treated in the ED). The DNT decreased from 78 min to 66 min in 2020 and 57 min in 2021 (p = 0.01). Conclusion Acute stroke care continued to be a priority despite the COVID-19 pandemic. The implementation of a thrombolytic bolus and the start of continuous infusion on the CT scan table was the main factor that contributed to the reduction of DNT. Continuous monitoring of service times is essential for improving the quality of the stroke center and achieving better functional outcomes for patients.
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Affiliation(s)
- Marcelo Klu
- Emergency Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ana Claudia de Souza
- Neurology Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Neurology Department, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Leonardo Augusto Carbonera
- Neurology Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Neurology Department, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Thais Leite Secchi
- Neurology Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Neurology Department, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Arthur Pille
- Neurology Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Neurology Department, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Marcio Rodrigues
- Emergency Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rosane Brondani
- Neurology Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Andrea Garcia de Almeida
- Neurology Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Neurology Department, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Angélica Dal Pizzol
- Neurology Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Neurology Department, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Daniel Monte Freire Camelo
- Neurology Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Neurology Department, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Gabriel Paulo Mantovani
- Neurology Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Carolina Oldoni
- Neurology Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marcelo Somma Tessari
- Neurology Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Luiz Antonio Nasi
- Emergency Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Sheila Cristina Ouriques Martins
- Neurology Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Neurology Department, Hospital Moinhos de Vento, Porto Alegre, Brazil
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Rosales J, Corredor-Quintero ÁB, Carbonera LA, Alet MJ, Amaya P, Cano-Nigenda V, Barboza MA, Navia V, Jiménez CA, Guerrero R, de Souza AC. Regional Initiatives to Empower Young Medical Doctors: The Young Stroke Latin American Task Force. Cerebrovasc Dis 2023; 53:233-238. [PMID: 37399805 DOI: 10.1159/000531649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/16/2023] [Indexed: 07/05/2023] Open
Affiliation(s)
- Julieta Rosales
- Vascular Neurology Division, Department of Neurology, Fleni, Buenos Aires, Argentina
| | | | | | - Matías J Alet
- Vascular Neurology Division, Department of Neurology, Fleni, Buenos Aires, Argentina
| | - Pablo Amaya
- Department of Neurology, Stroke Program, Fundación Valle del Lili, Cali, Colombia
| | - Vanessa Cano-Nigenda
- Stroke clinic, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - Miguel A Barboza
- Neurosciences Department, Hospital Dr. Rafael A. Calderón Guardia, CCSS, San José, Costa Rica
| | - Victor Navia
- Department of Medicine Clínica, Cerebrovascular Program, Neurology Service, Alemana de Santiago, Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile
| | - Claudio Alejandro Jiménez
- Head of Neurology and Director of the Stroke Center, Hospital Simón Bolívar, Subred Norte, Bogotá, Colombia
| | - Rodrigo Guerrero
- Neurology Department, Hospital de Santa Cruz, Clínica Santa María, Santiago, Chile
| | - Ana Cláudia de Souza
- Department of Neurology and Neurosurgery, Hospital Moinhos de Vento, Porto Alegre, Brazil
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Carbonera LA, Souza ACD, Rodrigues MDS, Mottin MD, Nogueira RG, Martins SCO. FAST-ED scale for prehospital triage of large vessel occlusion: results in the field. Arq Neuropsiquiatr 2022; 80:885-892. [PMID: 36261126 PMCID: PMC9770065 DOI: 10.1055/s-0042-1755536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Acute ischemic stroke (AIS) is an extremely time-sensitive condition. The field triage of stroke patients should consider a careful balance between the best destination for the timely delivery of intravenous and/or endovascular reperfusion therapies. The Field Assessment Stroke Triage for Emergency Destination (FAST-ED) scale has been shown to have an accuracy comparable to that of the National Institutes of Health Stroke Scale (NIHSS). However, it has not been tested in the field. OBJECTIVE To evaluate the accuracy of the FAST-ED scale in the detection of AIS due to large vessel occlusion (LVO) in the prehospital setting. METHODS A cross-sectional study of consecutive prospective data collected from February 2017 to May 2019 in the city of Porto Alegre, state of Rio Grande do Sul, Southern Brazil, correlating the prehospital FAST-ED scale scores with the hospital diagnosis of LVO. Area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. RESULTS In total, 74 patients were included in the analysis. As compared with the diagnosis of LVO upon hospital discharge, the prehospital FAST-ED scale applied by paramedics had a sensitivity of 80%, a specificity of 47.7%, a PPV of 51.1%, an NPV of 77.8%, and an AUC of 0.68 (95% confidence interval [95%CI]: 0.55-0.80). Among the patients with a final diagnosis of AIS, the accuracy was higher, with an AUC of 0.75 (95%CI: 0.60-0.89), a sensitivity of 80%, a specificity of 60%, a PPV of 80%, and an NPV of 60%. CONCLUSIONS In the present study, the FAST-ED scale, which was applied by paramedics in the field, demonstrated moderate accuracy but high sensitivity and NPV, which are essential attributes for a triage scale. While larger studies are still needed, these findings further support the use of the FAST-ED in stroke triage.
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Affiliation(s)
- Leonardo Augusto Carbonera
- Hospital de Clínicas de Porto Alegre, Grupo de Pesquisa em Neurologia Vascular, Departamento de Neurologia, Porto Alegre RS, Brazil.,Hospital Moinhos de Vento, Departamento de Neurologia e Neurocirurgia, Porto Alegre RS, Brazil.,Address for correspondence Leonardo Augusto Carbonera
| | - Ana Claudia de Souza
- Hospital de Clínicas de Porto Alegre, Grupo de Pesquisa em Neurologia Vascular, Departamento de Neurologia, Porto Alegre RS, Brazil.,Hospital Moinhos de Vento, Departamento de Neurologia e Neurocirurgia, Porto Alegre RS, Brazil.
| | | | | | - Raul Gomes Nogueira
- Emory University School of Medicine, Neurology Department, Atlanta, United States.
| | - Sheila Cristina Ouriques Martins
- Hospital de Clínicas de Porto Alegre, Grupo de Pesquisa em Neurologia Vascular, Departamento de Neurologia, Porto Alegre RS, Brazil.,Hospital Moinhos de Vento, Departamento de Neurologia e Neurocirurgia, Porto Alegre RS, Brazil.,Universidade Federal do Rio Grande do Sul, Departamento de Medicina Interna, Porto Alegre RS, Brazil.
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9
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Martins SCO, Borelli WV, Secchi TL, Mantovani GP, Pille A, Mora Cuervo DL, Carbonera LA, de Souza AC, Martins MCO, Brondani R, de Almeida AG, Dal Pizzol A, dos Santos FP, Alves AC, Meier NS, Andrade GPB, Maciel PA, Weber A, Machado GD, Parrini M, Nasi LA. Disparities in Stroke Patient-Reported Outcomes Measurement Between Healthcare Systems in Brazil. Front Neurol 2022; 13:857094. [PMID: 35599734 PMCID: PMC9120355 DOI: 10.3389/fneur.2022.857094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/24/2022] [Indexed: 01/01/2023] Open
Abstract
Introduction Acute stroke interventions, such as stroke units and reperfusion therapy, have the potential to improve outcomes. However, there are many disparities in patient characteristics and access to the best stroke care. Thus, we aim to compare patient-reported outcome measures (PROMs) after stroke in two stroke centers representing the public and private healthcare systems in Brazil. Methods PROMs through the International Consortium for Health Outcomes Measures (ICHOM) were assessed at 90 days after the stroke to compare two Brazilian hospitals in southern Brazil: a public university and a private stroke center, both with stroke protocols and stroke units. Results When compared with the private setting (n = 165), patients from the public hospital (n = 175) were younger, had poorer control of risk factors, had more frequent previous strokes, and arrived with more severe strokes. Both hospitals had a similar percentage of IV thrombolysis treatment. Only 5 patients received mechanical thrombectomy (MT), all in the private hospital. Public hospital patients presented significantly worse outcomes at 3 months, including worse quality of life and functional dependence (60 vs. 48%, p = 0.03). Poor outcome, as measured by the mRS score, was significantly associated with older age, higher NIHSS score, and the presence of heart failure. However, the public practice was a strong predictor of any self-reported disability. Conclusion Patients assisted at a good quality public stroke center with the same protocol used in the private hospital presented worse disability as measured by mRS and patient-reported outcome measures, with greater inability to communicate, dress, toilet, feed, and walk.
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Affiliation(s)
- Sheila Cristina Ouriques Martins
- Hospital Moinhos de Vento, Neurology Service and Postgraduate in Stroke Neurology, Porto Alegre, Brazil
- Hospital de Clínicas de Porto Alegre, Neurology Service, Porto Alegre, Brazil
- Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Brazilian Stroke Network, Porto Alegre, Brazil
- *Correspondence: Sheila Cristina Ouriques Martins
| | - Wyllians Vendramini Borelli
- Hospital de Clínicas de Porto Alegre, Neurology Service, Porto Alegre, Brazil
- Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Universidade Federal do Rio Grande do Sul, Pharmacology and Therapeutics Research Program, Porto Alegre, Brazil
- Wyllians Vendramini Borelli
| | - Thais Leite Secchi
- Hospital Moinhos de Vento, Neurology Service and Postgraduate in Stroke Neurology, Porto Alegre, Brazil
- Hospital de Clínicas de Porto Alegre, Neurology Service, Porto Alegre, Brazil
- Brazilian Stroke Network, Porto Alegre, Brazil
- Universidade Federal do Rio Grande do Sul, Postgraduate in Medical Sciences, Porto Alegre, Brazil
| | - Gabriel Paulo Mantovani
- Hospital de Clínicas de Porto Alegre, Neurology Service, Porto Alegre, Brazil
- Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Brazilian Stroke Network, Porto Alegre, Brazil
| | - Arthur Pille
- Hospital de Clínicas de Porto Alegre, Neurology Service, Porto Alegre, Brazil
- Brazilian Stroke Network, Porto Alegre, Brazil
- Universidade Federal do Rio Grande do Sul, Postgraduate in Medical Sciences, Porto Alegre, Brazil
| | - Daissy Liliana Mora Cuervo
- Hospital Moinhos de Vento, Neurology Service and Postgraduate in Stroke Neurology, Porto Alegre, Brazil
- Brazilian Stroke Network, Porto Alegre, Brazil
| | - Leonardo Augusto Carbonera
- Hospital Moinhos de Vento, Neurology Service and Postgraduate in Stroke Neurology, Porto Alegre, Brazil
- Brazilian Stroke Network, Porto Alegre, Brazil
| | - Ana Claudia de Souza
- Hospital Moinhos de Vento, Neurology Service and Postgraduate in Stroke Neurology, Porto Alegre, Brazil
- Brazilian Stroke Network, Porto Alegre, Brazil
- Universidade Federal do Rio Grande do Sul, Postgraduate in Medical Sciences, Porto Alegre, Brazil
| | - Magda Carla Ouriques Martins
- Hospital Moinhos de Vento, Neurology Service and Postgraduate in Stroke Neurology, Porto Alegre, Brazil
- Hospital de Clínicas de Porto Alegre, Neurology Service, Porto Alegre, Brazil
- Brazilian Stroke Network, Porto Alegre, Brazil
| | - Rosane Brondani
- Hospital de Clínicas de Porto Alegre, Neurology Service, Porto Alegre, Brazil
- Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Brazilian Stroke Network, Porto Alegre, Brazil
| | - Andrea Garcia de Almeida
- Hospital Moinhos de Vento, Neurology Service and Postgraduate in Stroke Neurology, Porto Alegre, Brazil
- Hospital de Clínicas de Porto Alegre, Neurology Service, Porto Alegre, Brazil
- Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Brazilian Stroke Network, Porto Alegre, Brazil
| | - Angélica Dal Pizzol
- Hospital Moinhos de Vento, Neurology Service and Postgraduate in Stroke Neurology, Porto Alegre, Brazil
- Hospital de Clínicas de Porto Alegre, Neurology Service, Porto Alegre, Brazil
- Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Brazilian Stroke Network, Porto Alegre, Brazil
| | - Franciele Pereira dos Santos
- Hospital Moinhos de Vento, Neurology Service and Postgraduate in Stroke Neurology, Porto Alegre, Brazil
- Hospital de Clínicas de Porto Alegre, Neurology Service, Porto Alegre, Brazil
- Brazilian Stroke Network, Porto Alegre, Brazil
| | - Ana Claudia Alves
- Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Nathalia Soares Meier
- Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | | | - Pedro Angst Maciel
- Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Alexandre Weber
- Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Gustavo Dariva Machado
- Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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10
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de Souza AC, Carbonera LA, Rocha E. Paid Parental Leave: Different Scenarios Around the World. Stroke 2021; 53:e23-e25. [PMID: 34875843 DOI: 10.1161/strokeaha.121.035919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ana Claudia de Souza
- Department of Neurology and Neurosurgery, Hospital Moinhos de Vento, Porto Alegre, Brazil (A.C.d.S., L.A.C.)
| | - Leonardo Augusto Carbonera
- Department of Neurology and Neurosurgery, Hospital Moinhos de Vento, Porto Alegre, Brazil (A.C.d.S., L.A.C.)
| | - Eva Rocha
- Department of Neurology and Neurosurgery (ER), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil (E.R.)
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11
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de Souza AC, Martins SO, Polanczyk CA, Araújo DV, Etges APB, Zanotto BS, Neyeloff JL, Carbonera LA, Chaves MLF, de Carvalho JJF, Rebello LC, Abud DG, Cabral LS, Lima FO, Mont'Alverne F, Sc Magalhães P, Diegoli H, Safanelli J, André Silveira Salvetti T, de Sousa Mendes Parente B, Eli Frudit M, Silva GS, Pontes-Neto OM, Nogueira RG. Cost-effectiveness of mechanical thrombectomy for acute ischemic stroke in Brazil: Results from the RESILIENT trial. Int J Stroke 2021; 17:17474930211055932. [PMID: 34730045 DOI: 10.1177/17474930211055932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The RESILIENT trial demonstrated the clinical benefit of mechanical thrombectomy in patients presenting acute ischemic stroke secondary to anterior circulation large vessel occlusion in Brazil. AIMS This economic evaluation aims to assess the cost-utility of mechanical thrombectomy in the RESILIENT trial from a public healthcare perspective. METHODS A cost-utility analysis was applied to compare mechanical thrombectomy plus standard medical care (n = 78) vs. standard medical care alone (n = 73), from a subset sample of the RESILIENT trial (151 of 221 patients). Real-world direct costs were considered, and utilities were imputed according to the Utility-Weighted modified Rankin Score. A Markov model was structured, and probabilistic and deterministic sensitivity analyses were performed to evaluate the robustness of results. RESULTS The incremental costs and quality-adjusted life years gained with mechanical thrombectomy plus standard medical care were estimated at Int$ 7440 and 1.04, respectively, compared to standard medical care alone, yielding an incremental cost-effectiveness ratio of Int$ 7153 per quality-adjusted life year. The deterministic sensitivity analysis demonstrated that mRS-6 costs of the first year most affected the incremental cost-effectiveness ratio. After 1000 simulations, most of results were below the cost-effective threshold. CONCLUSIONS The intervention's clear long-term benefits offset the initially higher costs of mechanical thrombectomy in the Brazilian public healthcare system. Such therapy is likely to be cost-effective and these results were crucial to incorporate mechanical thrombectomy in the Brazilian public stroke centers.
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Affiliation(s)
- Ana Claudia de Souza
- Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Sheila O Martins
- Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Carisi Anne Polanczyk
- National Institute of Science and Technology for Health Technology Assessment (IATS), Porto Alegre, Brazil
| | | | - Ana Paula Bs Etges
- National Institute of Science and Technology for Health Technology Assessment (IATS), Porto Alegre, Brazil
| | - Bruna Stella Zanotto
- National Institute of Science and Technology for Health Technology Assessment (IATS), Porto Alegre, Brazil
| | - Jeruza Lavanholi Neyeloff
- National Institute of Science and Technology for Health Technology Assessment (IATS), Porto Alegre, Brazil
| | | | | | - João José Freitas de Carvalho
- Department of Neurology, Hospital Geral de Fortaleza, Fortaleza, Brazil
- Department of Neurology, University of Fortaleza, Fortaleza, Brazil
| | - Letícia Costa Rebello
- Department of Neurology, 283325Hospital de Base do Distrito Federal, Brasilia, Brazil
| | - Daniel Giansante Abud
- Department of Interventional Neuroradiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Lucas Scotta Cabral
- Department of Interventional Neuroradiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Fabrício O Lima
- Department of Neurology, Hospital Geral de Fortaleza, Fortaleza, Brazil
| | - Francisco Mont'Alverne
- Department of Neurology, Hospital Geral de Fortaleza, Fortaleza, Brazil
- Department of Interventional Neuroradiology, Hospital Geral de Fortaleza, Fortaleza, Brazil
- Department of Post-Graduation Medical Sciences, University of Fortaleza, Fortaleza, Brazil
| | - Pedro Sc Magalhães
- Stroke Neurology Division, Hospital Municipal de Joinville, Joinville, Brazil
| | - Henrique Diegoli
- Stroke Neurology Division, Hospital Municipal de Joinville, Joinville, Brazil
| | - Juliana Safanelli
- Stroke Neurology Division, Hospital Municipal de Joinville, Joinville, Brazil
| | | | | | - Michel Eli Frudit
- Department of Interventional Neuroradiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Gisele Sampaio Silva
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Octávio M Pontes-Neto
- Stroke Service Neurology Division, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Raul G Nogueira
- Department of Neurology, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, USA
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12
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Martins SCO, Lavados P, Secchi TL, Brainin M, Ameriso S, Gongora-Rivera F, Sacks C, Cantú-Brito C, Alvarez Guzman TF, Pérez-Romero GE, Muñoz Collazos M, Barboza MA, Arauz A, Abanto Argomedo C, Novarro-Escudero N, Amorin Costabile HI, Crosa R, Camejo C, Mernes R, Maldonado N, Mora Cuervo DL, Pontes Neto OM, Silva GS, Carbonera LA, de Souza AC, de Sousa EDG, Flores A, Melgarejo D, Santos Carquin IR, Hoppe A, de Carvalho JJF, Mont'Alverne F, Amaya P, Bayona H, Navia González VH, Duran JC, Urrutia VC, Araujo DV, Feigin VL, Nogueira RG. Fighting Against Stroke in Latin America: A Joint Effort of Medical Professional Societies and Governments. Front Neurol 2021; 12:743732. [PMID: 34659101 PMCID: PMC8517273 DOI: 10.3389/fneur.2021.743732] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 08/30/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Stroke is one of the leading causes of death in Latin America, a region with countless gaps to be addressed to decrease its burden. In 2018, at the first Latin American Stroke Ministerial Meeting, stroke physician and healthcare manager representatives from 13 countries signed the Declaration of Gramado with the priorities to improve the region, with the commitment to implement all evidence-based strategies for stroke care. The second meeting in March 2020 reviewed the achievements in 2 years and discussed new objectives. This paper will review the 2-year advances and future plans of the Latin American alliance for stroke. Method: In March 2020, a survey based on the Declaration of Gramado items was sent to the neurologists participants of the Stroke Ministerial Meetings. The results were confirmed with representatives of the Ministries of Health and leaders from the countries at the second Latin American Stroke Ministerial Meeting. Results: In 2 years, public stroke awareness initiatives increased from 25 to 75% of countries. All countries have started programs to encourage physical activity, and there has been an increase in the number of countries that implement, at least partially, strategies to identify and treat hypertension, diabetes, and lifestyle risk factors. Programs to identify and treat dyslipidemia and atrial fibrillation still remained poor. The number of stroke centers increased from 322 to 448, all of them providing intravenous thrombolysis, with an increase in countries with stroke units. All countries have mechanical thrombectomy, but mostly restricted to a few private hospitals. Pre-hospital organization remains limited. The utilization of telemedicine has increased but is restricted to a few hospitals and is not widely available throughout the country. Patients have late, if any, access to rehabilitation after hospital discharge. Conclusion: The initiative to collaborate, exchange experiences, and unite societies and governments to improve stroke care in Latin America has yielded good results. Important advances have been made in the region in terms of increasing the number of acute stroke care services, implementing reperfusion treatments and creating programs for the detection and treatment of risk factors. We hope that this approach can reduce inequalities in stroke care in Latin America and serves as a model for other under-resourced environments.
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Affiliation(s)
- Sheila Cristina Ouriques Martins
- Hospital Moinhos de Vento, Porto Alegre, Brazil.,Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Brazilian Stroke Network, Porto Alegre, Brazil.,World Stroke Organization, Geneva, Switzerland
| | - Pablo Lavados
- Clinica Alemana, Universidad del Desarollo, Santiago, Chile
| | - Thaís Leite Secchi
- Hospital Moinhos de Vento, Porto Alegre, Brazil.,Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Brazilian Stroke Network, Porto Alegre, Brazil
| | - Michael Brainin
- World Stroke Organization, Geneva, Switzerland.,Department of Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems an der Donau, Austria
| | - Sebastian Ameriso
- Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia, Buenos Aires, Argentina
| | - Fernando Gongora-Rivera
- Servicio de Neurología - Unidad Neurovascular, Hospital Universitario José Eleuterio González, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico.,Instituto de Neurología y Neurocirugía, Centro Médico Zambrano Hellion, Tec Salud, San Pedro Garza García, Mexico.,Centro de Investigación y Desarrollo en Ciencias de la Salud, Universidad Aiutónoma de Nuevo León, Monterrey, Mexico
| | - Claudio Sacks
- Department of Neurology, Universidad del Valparaiso, Valparaiso, Chile
| | - Carlos Cantú-Brito
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | - Tony Fabian Alvarez Guzman
- Hospital Regional Manuela Beltran, Socorro, Colombia.,Asociación Colombiana de Neurología, Bogotá, Colombia
| | - Germán Enrique Pérez-Romero
- Asociación Colombiana de Neurología, Bogotá, Colombia.,Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia.,Fundación Hospital San Carlos, Bogotá, Colombia
| | | | - Miguel A Barboza
- Hospital Dr. Rafael A. Calderon, Neuroscience Department, San José, Costa Rica
| | - Antonio Arauz
- Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Clínica de Enfermedad Vascular Cerebral, Ciudad de México, Mexico
| | - Carlos Abanto Argomedo
- Departamento de Enfermedades Neurovasculares, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | | | | | | | | | - Ricardo Mernes
- Hospital de Clinicas, Faculdad de Medicina, Universidad Nacional de Asuncion, San Lorenzo, Paraguay
| | - Nelson Maldonado
- Hospital Central del Instituto de Previsión Social, Asunción, Paraguay
| | | | - Octávio Marques Pontes Neto
- Brazilian Stroke Network, Porto Alegre, Brazil.,Universidad San Francisco de Quito, Hospital de los Valles, Quito, Ecuador.,Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Gisele Sampaio Silva
- Brazilian Stroke Network, Porto Alegre, Brazil.,Brazilian Stroke Society, São Paulo, Brazil.,Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil.,Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Ana Claudia de Souza
- Hospital Moinhos de Vento, Porto Alegre, Brazil.,Brazilian Stroke Network, Porto Alegre, Brazil
| | | | - Alan Flores
- Hospital de Clinicas, Faculdad de Medicina, Universidad Nacional de Asuncion, San Lorenzo, Paraguay
| | - Donoban Melgarejo
- Hospital de Clinicas, Faculdad de Medicina, Universidad Nacional de Asuncion, San Lorenzo, Paraguay.,Hospital Central del Instituto de Previsión Social, Asunción, Paraguay
| | - Irving R Santos Carquin
- Emergency Hospital Public Assistance, Santiago, Chile.,Faculty of Medicine, University of Chile, Santiago, Chile.,Ministry of Health, Santiago, Chile
| | - Arnold Hoppe
- Clinica Alemana, Universidad del Desarollo, Santiago, Chile.,Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile
| | | | - Francisco Mont'Alverne
- Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile.,Sociedade Brazileira de Neurorradiologia Diagnóstica e Terapêutica, São Paulo, Brazil
| | - Pablo Amaya
- Servicio de Neurología - Unidad Neurovascular, Hospital Universitario José Eleuterio González, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico.,Asociación Colombiana de Neurología, Bogotá, Colombia.,Fundación Valle del Lili, Cali, Colombia
| | - Hernan Bayona
- Asociación Colombiana de Neurología, Bogotá, Colombia.,Fundación Santa Fé de Bogotá, Bogotá, Colombia
| | | | | | - Victor C Urrutia
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Denizar Vianna Araujo
- Ministry of Health, Brasília, Brazil.,Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Raul G Nogueira
- Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University, Atlanta, GA, United States
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13
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Heit JJ, Coelho H, Lima FO, Granja M, Aghaebrahim A, Hanel R, Kwok K, Haerian H, Cereda CW, Venkatasubramanian C, Dehkharghani S, Carbonera LA, Wiener J, Copeland K, Mont'Alverne F. Automated Cerebral Hemorrhage Detection Using RAPID. AJNR Am J Neuroradiol 2020; 42:273-278. [PMID: 33361378 DOI: 10.3174/ajnr.a6926] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/13/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Intracranial hemorrhage (ICH) is an important event that is diagnosed on head NCCT. Increased NCCT utilization in busy hospitals may limit timely identification of ICH. RAPID ICH is an automated hybrid 2D-3D convolutional neural network application designed to detect ICH that may allow for expedited ICH diagnosis. We determined the accuracy of RAPID ICH for ICH detection and ICH volumetric quantification on NCCT. MATERIALS AND METHODS NCCT scans were evaluated for ICH by RAPID ICH. Consensus detection of ICH by 3 neuroradiology experts was used as the criterion standard for RAPID ICH comparison. ICH volume was also automatically determined by RAPID ICH in patients with intraparenchymal or intraventricular hemorrhage and compared with manually segmented ICH volumes by a single neuroradiology expert. ICH detection accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratios by RAPID ICH were determined. RESULTS We included 308 studies. RAPID ICH correctly identified 151/158 ICH cases and 143/150 ICH-negative cases, which resulted in high sensitivity (0.956, CI: 0.911-0.978), specificity (0.953, CI: 0.907-0.977), positive predictive value (0.956, CI: 0.911-0.978), and negative predictive value (0.953, CI: 0.907-0.977) for ICH detection. The positive likelihood ratio (20.479, CI 9.928-42.245) and negative likelihood ratio (0.046, CI 0.023-0.096) for ICH detection were similarly favorable. RAPID ICH volumetric quantification for intraparenchymal and intraventricular hemorrhages strongly correlated with expert manual segmentation (correlation coefficient r = 0.983); the median absolute error was 3 mL. CONCLUSIONS RAPID ICH is highly accurate in the detection of ICH and in the volumetric quantification of intraparenchymal and intraventricular hemorrhages.
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Affiliation(s)
- J J Heit
- From the Department of Radiology, Neuroimaging, and Neurointervention Division (J.J.H.), Stanford University School of Medicine, Stanford, California
| | - H Coelho
- Interventional Radiology Service (H.C., F.M.)
| | - F O Lima
- Department of Neurology (F.O.L.), Hospital Geral de Fortaleza, R. Ávila Goulart, Fortaleza, Brazil
| | - M Granja
- Baptist Neurological Institute (M.G., A.A., R.H.), Lyerly Neurosurgery/Baptist Health, Jacksonville, Florida.,Diagnostic Imaging Department (M.G., A.A., R.H.), Fundación Santa Fe de Bogota University Hospital, Bogotá, Colombia
| | - A Aghaebrahim
- Baptist Neurological Institute (M.G., A.A., R.H.), Lyerly Neurosurgery/Baptist Health, Jacksonville, Florida.,Diagnostic Imaging Department (M.G., A.A., R.H.), Fundación Santa Fe de Bogota University Hospital, Bogotá, Colombia
| | - R Hanel
- Baptist Neurological Institute (M.G., A.A., R.H.), Lyerly Neurosurgery/Baptist Health, Jacksonville, Florida.,Diagnostic Imaging Department (M.G., A.A., R.H.), Fundación Santa Fe de Bogota University Hospital, Bogotá, Colombia
| | - K Kwok
- Department of Radiology (K.K.), Central Valley Imaging Medical Associates, Manteca, California
| | - H Haerian
- Department of Radiology (H.H.), LifeBridge Health, Baltimore, Maryland
| | - C W Cereda
- Department of Neurology (C.W.C.), EOC Ospedale Regionale di Lugano, Lugano, Switzerland
| | - C Venkatasubramanian
- Neurocritical Care and Stroke, Department of Neurology (C.V.), Stanford University, Palo Alto, California
| | - S Dehkharghani
- Department of Radiology (S.D.), NY University Langone Health, New York, New York
| | - L A Carbonera
- Hospital das Clínicas de Porto Alegre (L.A.C.), Bairro Santa Cecilia, Brazil
| | - J Wiener
- Department of Radiology (J.W.), Boca Raton Regional Hospital, Boca Raton, Florida
| | - K Copeland
- Boulder Statistics (K.C.), Steamboat Springs, Colorado
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