Abstract
Background and Purpose: CT perfusion (CTP) has been implemented widely in regional areas of Australia for telestroke assessment. The aim of this study was to determine if, as part of telestroke assessment, CTP provided added benefit to clinical features in distinguishing between strokes and mimic and between transient ischaemic attack (TIA) and mimic.Methods: We retrospectively analysed 1,513 consecutively recruited patients referred to the Northern New South Wales Telestroke service, where CTP is performed as a part of telestroke assessment. Patients were classified based on the final diagnosis of stroke, TIA, or mimic. Multivariate regression models were used to determine factors that could be used to differentiate between stroke and mimic and between TIA and mimic.Results: There were 693 strokes, 97 TIA, and 259 mimics included in the multivariate regression models. For the stroke vs. mimic model using symptoms only, the area under the curve (AUC) on the receiver operator curve (ROC) was 0.71 (95% CI 0.67–0.75). For the stroke vs. mimic model using the absence of ischaemic lesion on CTP in addition to clinical features, the AUC was 0.90 (95% CI 0.88–0.92). The multivariate regression model for predicting mimic from TIA using symptoms produced an AUC of 0.71 (95% CI 0.65–0.76). The addition of absence of an ischaemic lesion on CTP to clinical features for the TIA vs. mimic model had an AUC of 0.78 (95% CI 0.73–0.83)Conclusions: In the telehealth setting, the absence of an ischaemic lesion on CTP adds to the diagnostic accuracy in distinguishing mimic from stroke, above that from clinical features.
Highlights
Access to reperfusion therapy for stroke is largely related to the timely and accurate diagnosis of stroke [1]
Telestroke with multimodal CT imaging, which includes non-contrast CT brain, CT angiography (CTA), and CT perfusion (CTP), has been demonstrated to be an effective way of increasing thrombolysis in these regions and has been used to select patients who are likely to benefit from transfer to a comprehensive stroke centre for endovascular thrombectomy [3]
1,513 patients were assessed over this time period by the Northern New South Wales Telestroke service, and 1,074 patients assessed had CTP and were included in this study
Summary
Access to reperfusion therapy for stroke is largely related to the timely and accurate diagnosis of stroke [1]. Telestroke with multimodal CT (mCT) imaging, which includes non-contrast CT brain, CT angiography (CTA), and CT perfusion (CTP), has been demonstrated to be an effective way of increasing thrombolysis in these regions and has been used to select patients who are likely to benefit from transfer to a comprehensive stroke centre for endovascular thrombectomy [3]. Accurate diagnosis of stroke mimics from stroke and transient ischaemic attack (TIA) is required to avoid unnecessary treatment and transfer of patients in the telestroke setting. Most of the research differentiating ischaemic events from mimics has focused primarily on face-to-face clinical assessment in the Emergency Department [4–8]. The aim of this study was to determine if, as part of telestroke assessment, CTP provided added benefit to clinical features in distinguishing between strokes and mimic and between transient ischaemic attack (TIA) and mimic
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