Christopher G. Favilla MD , Michael T. Mullen MD , Soren Konecky PhD , Tyler McCardell MD , Ryan A. McTaggart MD , Grayson L. Baird PhD
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Pre-hospital LVO detection: One size does not fit all
A range of techniques are being developed with the goal of leverage physiologic data to detect large vessel occlusion (LVO) in the prehospital setting. The output of most every technique is a continuous (or ordinal) variable, but a threshold is applied to yield a simplified binary outcome (i.e., high-likelihood LVO vs low-likelihood LVO). The mathematically optimal threshold is typically selected to balance sensitivity and specificity. Though intuitive, this approach may not appropriately account for the relative significance of false negatives and false positives. Most importantly, relying on a single threshold is an unnecessary oversimplification, and this one-size-fits-all approach to prehospital LVO detection does not optimally account for the diversity of prehospital systems of care. Here, we use a recently reported technique, optical blood flow imaging, to demonstrate how thresholds can be easily titrated in favor of sensitivity or specificity and thereby provide options that may better serve any given micro-environment.
期刊介绍:
The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.