Automated detection of intracranial large vessel occlusions using Viz.ai software: Experience in a large, integrated stroke network

Abstract Background and purpose Endovascular thrombectomy is an evidence‐based treatment for large vessel occlusion (LVO) stroke. Commercially available artificial intelligence has been designed to detect the presence of an LVO on computed tomography angiogram (CTA). We compared Viz.ai‐LVO (San Francisco, CA, USA) to CTA interpretation by board‐certified neuroradiologists (NRs) in a large, integrated stroke network. Methods From January 2021 to December 2021, we compared Viz.ai detection of an internal carotid artery (ICA) or middle cerebral artery first segment (MCA‐M1) occlusion to the gold standard of CTA interpretation by board‐certified NRs for all code stroke CTAs. On a monthly basis, sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Trend analyses were conducted to evaluate for any improvement of LVO detection by the software over time. Results 3851 patients met study inclusion criteria, of whom 220 (5.7%) had an ICA or MCA‐M1 occlusion per NR. Sensitivity and specificity were 78.2% (95% CI 72%–83%) and 97% (95% CI 96%–98%), respectively. PPV was 61% (95% CI 55%–67%), NPV 99% (95% CI 98%–99%), and accuracy was 95.9% (95% CI 95.3%–96.5%). Neither specificity or sensitivity improved over time in the trend analysis. Conclusions Viz.ai‐LVO has high specificity and moderately high sensitivity to detect an ICA or proximal MCA occlusion. The software has the potential to streamline code stroke workflows and may be particularly impactful when emergency access to NRs or vascular neurologists is limited

Early depression screening is feasible in hospitalized stroke patients.

Post-stroke depression (PSD) is common but is not routinely assessed for in hospitalized patients. As a Comprehensive Stroke Center, we screen all stroke inpatients for depression, though the feasibility of early screening has not been established. We assessed the hypothesis that early depression screening in stroke patients is feasible. We also explored patient level factors associated with being screened for PSD and the presence of early PSD.The medical records of all patients admitted with ischemic stroke (IS) or intracerebral hemorrhage (ICH) between 01/02/13 and 15/04/13 were reviewed. A depression screen, modified from the Patient Health Questionnaire-9, was administered (maximum score 27, higher scores indicating worse depression). Patients were eligible if they did not have a medical condition precluding screening. Feasibility was defined as screening 75% of all eligible patients.Of 303 IS and ICH inpatients, 70% (211) were eligible for screening, and 75% (158) of all eligible patients were screened. More than one-third of all patients screened positive for depression (score > 4). Women (OR 2.06, 95% CI 1.06-4.01) and younger patients (OR 0.97, 95% CI 0.96-0.99) were more likely to screen positive. Screening positive was not associated with poor discharge/day 7 outcome (mRS > 3; OR 1.45, 95% CI 0.74-2.83).Screening stroke inpatients for depression is feasible and early depression after stroke is common. Women and younger patients are more likely to experience early PSD. Our results provide preliminary evidence supporting continued screening for depression in hospitalized stroke patients

Factors Associated With Being Screened for Post-Stroke Depression.

<p>* <i>Medians tested for equality using Wilcoxon rank-sum test</i>, <i>and 95% CI for difference between medians is reported</i></p><p>MPHQ-9 = Modified Patient Health Questionnaire-9.</p><p>Factors Associated With Being Screened for Post-Stroke Depression.</p

Factors Associated With Screening Positive for Post-Stroke Depression.

<p>MPHQ-9 = Modified Patient Health Questionnaire-9.</p><p>Factors Associated With Screening Positive for Post-Stroke Depression.</p

Patient Demographics, Co-morbidities, and Stroke Characteristics.

<p>Patient Demographics, Co-morbidities, and Stroke Characteristics.</p