Background

Prehospital detection of large vessel occlusion stroke of the anterior circulation (LVO-a) would enable direct transportation of these patients to an endovascular thrombectomy (EVT) capable hospital. The ongoing ELECTRA-STROKE study investigates the diagnostic accuracy of dry electrode electroencephalography (EEG) for LVO-a stroke in the prehospital setting. To determine which EEG features are most useful for this purpose and assess EEG data quality, EEG recordings are also performed in the emergency room (ER). Here, we report data of the first 100 patients included in the ER.

Methods

Patients presented to the ER with a suspected stroke or known LVO-a stroke underwent a single EEG prior to EVT. Diagnostic accuracy for LVO-a stroke of frequency band power, brain symmetry and phase synchronization measures were evaluated by calculating receiver operating characteristic curves. Optimal cut-offs were determined as the highest sensitivity at a specificity of ≥ 80%.

Results

EEG data were of sufficient quality for analysis in 65/100 included patients. Of these, 35/65 (54%) had an acute ischemic stroke, of whom 9/65 (14%) had an LVO-a stroke. Median onset-to-EEG-time was 266 min (IQR 121–655) and median EEG-recording-time was 3 min (IQR 3–5). The EEG feature with the highest diagnostic accuracy for LVO-a stroke was theta–alpha ratio (AUC 0.83; sensitivity 75%; specificity 81%). Combined, weighted phase lag index and relative theta power best identified LVO-a stroke (sensitivity 100%; specificity 84%).

Conclusion

Dry electrode EEG is a promising tool for LVO-a stroke detection, but data quality needs to be improved and validation in the prehospital setting is necessary. (TRN: NCT03699397, registered October 9 2018).

中文翻译：

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在急诊室用脑电图检测大血管闭塞性卒中：ELECTRA-STROKE 研究的初步结果

背景

前循环大血管闭塞性卒中 (LVO-a) 的院前检测将使这些患者能够直接运送到具有血管内血栓切除术 (EVT) 能力的医院。正在进行的 ELECTRA-STROKE 研究调查了院前环境中干电极脑电图 (EEG) 对 LVO-a 中风的诊断准确性。为了确定哪些 EEG 特征对此最有用并评估 EEG 数据质量，还在急诊室 (ER) 中进行 EEG 记录。在这里，我们报告了急诊室中前 100 名患者的数据。

方法

向急诊室就诊的疑似卒中或已知 LVO-a 卒中的患者在 EVT 前接受了一次 EEG。通过计算接收器工作特性曲线来评估 LVO-a 中风的频带功率、大脑对称性和相位同步测量的诊断准确性。最佳临界值被确定为特异性≥ 80% 时的最高灵敏度。

结果

EEG 数据的质量足以在 65/100 名患者中进行分析。其中，35/65 (54%) 患有急性缺血性卒中，其中 9/65 (14%) 患有 LVO-a 卒中。中位 EEG 起效时间为 266 分钟（IQR 121-655），中位 EEG 记录时间为 3 分钟（IQR 3-5）。对 LVO-a 卒中诊断准确度最高的 EEG 特征是 θ-α 比（AUC 0.83；敏感性 75%；特异性 81%）。综合加权相位滞后指数和相对 theta 功率最能识别 LVO-a 中风（敏感性 100%；特异性 84%）。

结论

干电极脑电图是一种很有前途的 LVO-a 卒中检测工具，但需要提高数据质量，并且需要在院前环境中进行验证。（TRN：NCT03699397，2018 年 10 月 9 日注册）。