Portable stroke detection devices: a systematic scoping review of prehospital applications

Abstract

Background The worldwide burden of stroke remains high, with increasing time-to-treatment correlated with worse outcomes. Yet stroke subtype determination, most importantly between stroke/non-stroke and ischemic/hemorrhagic stroke, is not confirmed until hospital CT diagnosis, resulting in suboptimal prehospital triage and delayed treatment. In this study, we survey portable, non-invasive diagnostic technologies that could streamline triage by making this initial determination of stroke type, thereby reducing time-to-treatment. Methods Following PRISMA guidelines, we performed a scoping review of portable stroke diagnostic devices. The search was executed in PubMed and Scopus, and all studies testing technology for the detection of stroke or intracranial hemorrhage were eligible for inclusion. Extracted data included type of technology, location, feasibility, time to results, and diagnostic accuracy. Results After a screening of 296 studies, 16 papers were selected for inclusion. Studied devices utilized various types of diagnostic technology, including near-infrared spectroscopy (6), ultrasound (4), electroencephalography (4), microwave technology (1), and volumetric impedance spectroscopy (1). Three devices were tested prior to hospital arrival, 6 were tested in the emergency department, and 7 were tested in unspecified hospital settings. Median measurement time was 3 minutes (IQR: 3 minutes to 5.6 minutes). Several technologies showed high diagnostic accuracy in severe stroke and intracranial hematoma detection. Conclusion Numerous emerging portable technologies have been reported to detect and stratify stroke to potentially improve prehospital triage. However, the majority of these current technologies are still in development and utilize a variety of accuracy metrics, making inter-technology comparisons difficult. Standardizing evaluation of diagnostic accuracy may be helpful in further optimizing portable stroke detection technology for clinical use.

Deep-Learning-Enabled Microwave-Induced Thermoacoustic Tomography Based on ResAttU-Net for Transcranial Brain Hemorrhage Detection

“…For potential clinical applications, it is meaningful to test if the proposed method can distinguish between and ischemic stroke [69].We make a new sample by embedding a 10-mm ischemia-mimicking phantom into porcine brain tissue. The contrast of the ischemia spot is −37% (within the reported range of ischemic stroke [60]), which means the microwave absorption in the spot is 37% lower than that in the porcine brain tissue.…”

Prehospital stroke management and mobile stroke units

“…In the future, we may see the use of novel technologies for detecting stroke and LVO in ambulances or MSUs, such as ultrasound techniques [38], electroencephalography [39], near-infrared spectroscopy, microwave technology and volumetric impedance spectroscopy [40].…”

Evolving Stroke Systems of Care: Stroke Diagnosis and Treatment in the Post-Thrombectomy Era

“…These devices utilize a variety of technological approaches, including accelerometers, electroencephalography (EEG), microwaves, near-infrared, and transcranial Doppler ultrasound to detect LVOs [ 42 ]. Though the concept is exciting and shows promise, a systematic review published in 2022 concluded that these technologies require further development [ 43 ]. Further, the lack of large, multicenter studies and the heterogeneity of study designs and populations in available literature prevent definitive statements about their clinical utility [ 43 ].…”

“…Though the concept is exciting and shows promise, a systematic review published in 2022 concluded that these technologies require further development [ 43 ]. Further, the lack of large, multicenter studies and the heterogeneity of study designs and populations in available literature prevent definitive statements about their clinical utility [ 43 ].…”