Clinical Uncertainty in Large Vessel Occlusion ischemic stroke (CULVO): Does automated perfusion scanning make a difference? Protocol of an intrarater and interrater agreement study.

Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE

Original Publication: San Francisco, CA : Public Library of Science

Brain Ischemia*/diagnostic imaging ; Brain Ischemia*/therapy ; Endovascular Procedures*/methods ; Ischemic Stroke* ; Stroke*/diagnostic imaging ; Stroke*/therapy; Humans ; Clinical Decision-Making ; Perfusion ; Reproducibility of Results ; Retrospective Studies ; Thrombectomy/methods ; Treatment Outcome ; Uncertainty

Background: Guidelines recommend the use of perfusion computed tomography (CT) to identify emergent large vessel ischemic stroke (ELVIS) patients who are likely to benefit from endovascular thrombectomy (EVT) if they present within 6-24 hour (late window) of stroke onset. We aim to determine if the interrater and intrarater reliability among physicians when recommending EVT is significantly different when perfusion CT or non-perfusion CT is reviewed.
Methods: A total of 30 non-consecutive patients will be selected from our institutional database comprising 3144 cranial CT scans performed for acute stroke symptoms January 2018 to August 2022. The clinical and radiologic data of the 30 patients will be presented in random order to a group of 29 physicians in two separate sessions at least three weeks apart. In each session, the physicians will evaluate each patient once with automated perfusion images and once without. We will use non-overlapping 95% confidence intervals and difference in agreement classification as criteria to suggest a difference between the Gwet AC1 statistics (κG).
Discussion: The results obtained from this study, combined with the clinical outcomes data of patients categorized through the two imaging techniques and a cost-effectiveness analysis, will offer a comprehensive evaluation of the clinical utility of perfusion CT neuroimaging. Should there be no significant disparity in the reliability of decisions made by clinicians using the two neuroimaging protocols, it may be necessary to revise existing recommendations regarding neuroimaging in the later time window to align with these findings.
Competing Interests: JBD: Honoraria from Medtronic. Travel grant from Microvention RF: Conflict of Interest: None. Disclosure of Funding: None. AB: Conflict of Interest: None. Disclosure of Funding: None. ATO: Conflict of Interest: None. Disclosure of Funding: None. VMP: Conflict of Interest: None. Disclosure of Funding: None. JS: Conflict of Interest: None. Disclosure of Funding: None. TRM: Principal of eVasc Neurovascular PD: Conflict of Interest: None. Disclosure of Funding: None. SS: Conflict of Interest: None. Disclosure of Funding: None. FF: Conflict of Interest: None. Disclosure of Funding: None. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
(Copyright: © 2024 Diestro et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

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Date Created: 20240130 Date Completed: 20240205 Latest Revision: 20241023

20250114

PMC10826946

10.1371/journal.pone.0297520

38289912