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Abstract Details

Analysis of Advanced Imaging Utilization in Low National Institutes of Health Stroke Scale Score and Rate of Large Vessel Occlusion Detection in Large Telestroke Database
Cerebrovascular Disease and Interventional Neurology
S24 - Cerebrovascular Disease and Interventional Neurology: Endovascular Thrombectomy and Large Vessel Occlusions (2:36 PM-2:48 PM)
009

The benefits of mechanical thrombectomy in low NIHSS score (<6) is unclear and undergoing investigation. Currently, great variation exists in practice patterns of computed tomography angiography (CTA) for patients with low NIHSS. Current guidelines do not address low NIHSS largely owing to a paucity of data. Better understanding of the rate of LVO associated with low NIHSS could help guide clinical practice and pave the way for expanding guideline recommendations.

Analyze the rate of large vessel occlusion (LVO) detection in low National Institutes of Health Stroke Scale (NIHSS) score patients in a large multicenter database.

Acute stroke consultations seen in the emergency department in 227 facilities (27 states) from July 1, 2021 to December 31, 2021 were extracted from the TeleCareTM database. The encounters seen within 24 hours of last known normal were reviewed for CTA performed, LVO detected, and NIHSS score. Multivariate analysis was performed to determine the odds ratio (OR) for CTA performed, and LVO found at each NIHSS score of 0-5 with reference of ≥6.

23,166 acute stroke encounters were included and 10,507 had CTA performed. There were lesser odds for CTA being performed among patients with an NIHSS of: 0 (OR=0.14, [0.13,0.15]); 1 (OR=0.16, [0.15,0.18]); 2 (OR=0.27, [0.24,0.3]); 3 (OR=0.33, [ 0.3,0.37]); 4 (OR=0.49, [0.43,0.55]); and 5 (OR=0.71, [0.61,0.82]). In addition, there were lesser odds of an LVO detected among patients with an NIHSS of: 0 (OR=0.1, [0.07,0.13]); 1 (OR=0.09, [0.06,0.12]); 2 (OR=0.16, [0.12,0.22]); 3 (OR=0.14, [0.1,0.2]); 4 (OR=0.24, [0.18,0.32]), and 5 (OR=0.27, [0.2,0.37]).

Analysis of our large telemedicine database demonstrated a significant number of LVOs detected with NIHSS <6, supporting lowering the minimum NIHSS score for emergent CTA. The cutoff of ≥4 may be optimal threshold for LVO capture. We suggest a rational approach to CTA performance to include patients with NIHSS ≥4 or cortical symptoms.

Authors/Disclosures
Theresa Beth Sevilis, DO, FAAN (Telespecialists, LLC)
PRESENTER
Dr. Sevilis has stock in Moderna.
Mariecken V. Fowler, MD, FAAN (MV Fowler MD PLLC) Dr. Fowler has nothing to disclose.
Amanda Avila, MD Dr. Avila has nothing to disclose.
Caitlyn Boyd, RN (TeleSpecialists) Ms. Boyd has nothing to disclose.
Oleg William Collins, Other (TeleSpecialists) Mr. Collins has nothing to disclose.
Lan Gao, PhD (University of Tennessee) Dr. Gao has nothing to disclose.
Gregory Wayne Heath, PhD (University of Tennessee) Dr. Heath has received personal compensation in the range of $0-$499 for serving as a Epidemiologic analysis consultant with Neuroscience Innovation Foundation .
Thomas G. Devlin, MD, PhD (Memorial Hospital) Dr. Devlin has received personal compensation for serving as an employee of Neuroscience Innovation Foundation. Dr. Devlin has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Nova Signal. Dr. Devlin has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Viz.ai. Dr. Devlin has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medtronic. Dr. Devlin has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Medtronic. Dr. Devlin has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Viz,ai. Dr. Devlin has received personal compensation in the range of $5,000-$9,999 for serving as an officer or member of the Board of Directors for Neuroscience Innovation Foundation. Dr. Devlin has stock in Nova Signal. Dr. Devlin has stock in Viz.ai. The institution of Dr. Devlin has received research support from Viz.ai. Dr. Devlin has received research support from Nova Signal. Dr. Devlin has received intellectual property interests from a discovery or technology relating to health care.