Abstract TP233: Clinical Predictors of Endovascular Stroke Treatment Among Emergency Department Patients Screened With Multimodal Computed Tomography

Abstract

Background: Endovascular therapy (EVT) offers dramatic benefit to selected patients with large vessel occlusion (LVO) ischemic stroke. However, identification of EVT candidates requires advanced imaging and often interfacility transfer. We sought to quantify the yield of such testing as well as identify clinical predictors of EVT candidacy. Methods: This retrospective cohort study identified consecutive Emergency Department (ED) patients with stroke symptoms who underwent CT angiogram and brain perfusion (CTA/P) imaging to assess for EVT candidacy. Demographics, medical history, clinical characteristics, final diagnosis, and outcomes were abstracted. We compared clinical characteristics among those who did and did not undergo EVT. Multivariable logistic regression was used to identify independent clinical predictors of EVT and derive a clinical prediction rule to quantify the probability of EVT. Results: Over a 12-month period, 835 patients underwent CTA/P imaging in the ED. EVT was undertaken for 116 (13.9%) patients; 321 (38.4%) ultimately received a non-stroke diagnosis. Patients who received EVT were older and had higher stroke scores (Table). Patients with an unknown last known well (LKW) time were less likely to receive EVT, however increasing time form LKW to door did not predict EVT (test for trend p=0.976). Multivariable analysis results are presented in the Table. A clinical decision rule based on the regression coefficients demonstrated moderately high discrimination for predicting EVT with an AUC of 0.79 (0.74 to 0.83). Among 102 patients transferred for CTA/P, 24 (24%) had and a score <1, none of whom received EVT. Conclusions: EVT Candidates are common among ED patients screened with CTA/P. Clinical factors can predict the likelihood of EVT candidacy. If validated in other populations, a simple clinical prediction rule may assist in triaging patients in need of urgent transfer to a thrombectomy-capable facility.