Background: Although spinal cord infarction (SCI) is a rare form of CNS injury, the long-term disability can be substantial. There are limited epidemiological data on the incidence and risk factors of SCI and most prior data were based on small case series of surgical patients. Objectives: To evaluate risk factors for SCI in a contemporary population-based sample, and compare the profiles of those with SCI to those with ischemic stroke and transverse myelitis. Methods: Using California state data on all patients discharged from nonfederal emergency departments or acute care hospitals between 2005 and 2011, we identified all patients with a discharge diagnosis of SCI (ICD9 code = 336.1), ischemic stroke (433.x1, 434.x1, or 436) and transverse myelitis (341.2, 341.3, or 323.82). Age, sex, race, and vascular risk factors were compared among these diagnoses subsets using the Chi square test. Results: The annual incidence of SCI (7 per million) was significantly less than that of stroke (1136 per million). The age of patients with SCI (60.8±18.8) was less than that for patients with stroke (72 ±14.4) but more than that for transverse myelitis (50.6 ±18.5). In general, patients with SCI had vascular risk factors more often than transverse myelitis patients but less often than stroke patients, with the exception of peripheral vascular disease, aortic dissection or rupture, and aortic surgery_all of which were more prevalent among SCI patients than stroke patients. Conclusion: In a large population-based sample of patients, we found that traditional vascular risk were less common with SCI than with ischemic stroke, while peripheral vascular disease and aortic disease or surgeries were more common.
Purpose: To compare physicians’ ability to read Alberta Stroke Program Early CT Score (ASPECTS) in patients with a large vessel occlusion within 6 hours of symptom onset when assisted by a machine learning-based automatic software tool, RAPID ASPECTS, compared with their unassisted score. Materials and Methods: 50 baseline CT scans selected from two prior studies (CRISP and GAMES-RP) were read by 3 experienced neuroradiologists who were provided access to a follow-up MRI. The average ASPECT score of these reads was used as the reference standard. Two additional neuroradiologists and 6 non-neuroradiologist readers then read the scans both with and without assistance from the RAPID ASPECTS software and reader improvement was determined. The primary hypothesis was that the agreement between typical readers and the consensus of 3 expert neuroradiologists would be improved with RAPID-assisted vs. unassisted reads. Agreement was based on the percentage of the individual ASPECT regions (50 cases, 10 regions each; N=500) where agreement was achieved. Results: Typical non-neuroradiologist readers agreed with the expert consensus read in 72% of the 500 ASPECTS regions, evaluated without software assistance. The automated software alone agreed in 77%. When the typical readers read the scan in conjunction with the software, agreement improved to 78% (P<0.0001, test of proportions). RAPID ASPECTS alone achieved correlations for total ASPECT scores that were similar to the expert readers who had access to the follow-up MRI scan to help enhance the quality of their reads. Conclusion: Typical readers had statistically significant improvement in their scoring of scans when the scan was read in conjunction with the automated RAPID ASPECTS software, achieving agreement rates that were comparable to neuroradiologists.
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