First Automated Stroke Imaging Evaluation via Electronic Alberta Stroke Program Early CT Score in a Mobile Stroke Unit

Abstract

Background: Recently, a mobile stroke unit (MSU) was shown to facilitate acute stroke treatment directly at the emergency site. The neuroradiological expertise of the MSU is improved by its ability to detect early ischemic damage via automatic electronic (e) evaluation of CT scans using a novel software program that calculates the electronic Alberta Stroke Program Early CT Score (e-ASPECTS). Methods: The feasibility of integrating e-ASPECTS into an ambulance was examined, and the clinical integration and utility of the software in 15 consecutive cases evaluated. Results: Implementation of e-ASPECTS onto the MSU and into the prehospital stroke management was feasible. The values of e-ASPECTS matched with the results of conventional neuroradiologic analysis by the MSU team. The potential benefits of e-ASPECTS were illustrated by three cases. In case 1, excluding early infarct signs supported the decision to directly perform prehospital thrombolysis. In case 2, in which stroke was caused by large-vessel occlusion, the high e-ASPECTS value supported the decision to initiate intra-arterial treatment and triage the patient to a comprehensive stroke center. In case 3, the e-ASPECTS value was 10, indicating the absence of early infarct signs despite pre-existing cerebral microangiopathy and macroangiopathy, a finding indicating the program's robustness against artefacts. Conclusions: This study on the integration of e-ASPECTS into the prehospital stroke management via a MSU showed for the first time that such integration is feasible, and aids both decision regarding the treatment option and the triage regarding the most appropriate target hospital.

Technological innovation for prehospital stroke triage: ripe for disruption

“…Software such as e-AS-PECTS has been successfully integrated into the MSU workflow, and it is likely that further integration of automated interpretation will occur in MSUs. 22 While studies have been able to demonstrate reductions in alarm-to-treatment times of up to 25-35 min and increased thrombolysis rates by as much as 12%, long-term outcomes of these cohorts have not been significantly different than their controls, particularly for excellent outcomes (mRS 0-1). [23][24][25][26] For mRS 0-3 and for mortality there may be advantages, suggesting that mRS shift may be a better measure to assess the impact of MSU.…”

Computer-aided imaging analysis in acute ischemic stroke – background and clinical applications

“…While so far only one study on the performance of RAPID ASPECTS has been published [18], there are several studies on the performance of e-ASPECTS within different settings and patient populations available [19][20][21][22][23][24]. All these studies indicate that these algorithms can be better than non-stroke experts and at least equal than experts in applying the ASPECTS to patients with acute ischemic stroke, yet they are not intended as a stand-alone diagnostic tool.…”

Bringing Emergency Neurology to Ambulances: Mobile Stroke Unit

“…MSUs are also an instrumental tool for research spanning broad domains, including biomarkers, 46,47 neuroimaging, 48 and cerebral physiology (via the use of noninvasive cerebral blood flow monitoring devices). 49 The effects of earlier administration of time-sensitive, adjunctive neuroprotective therapies with tPA, along with other hemostatic agents for ICH (i.e., tranexamic acid, factor VIIa) can also be potentially investigated.…”