Diagnostic value of non-invasive large vessel occlusion detection methods: A systematic review and meta-analysis.

In 30 seconds

This systematic review and meta-analysis assessed non-invasive prehospital tools for detecting large vessel occlusion (LVO), comparing their diagnostic performance with CT or MR angiography. Thirteen studies evaluated EEG or other neurophysiological monitoring, ultrasound methods, optical blood-flow monitoring, and cranial accelerometry. Across methods, pooled sensitivity was 87.4% (95% CI: 82.5-91.0) and specificity was 89.39% (95% CI: 83.0-93.5). TCD-based methods had the highest pooled diagnostic odds ratio, at 120.4 (95% CI: 76.9-188.7), although results varied significantly between studies.

Key findings

• Across all methods, pooled sensitivity was 87.4% (95% CI: 82.5-91.0) and specificity was 89.39% (95% CI: 83.0-93.5).
• The pooled diagnostic odds ratio was 52.7 (95% CI: 28.3-97.8), with significant heterogeneity (I 2 = 67.3%, P < 0.001).
• TCD-based methods had the highest diagnostic odds ratio (120.4, 95% CI: 76.9-188.7) and specificity (95.0%, 95% CI: 91.8-97.0).

Why it matters

Rapid prehospital recognition of LVO may inform stroke triage and access to reperfusion therapies. The pooled results suggest that portable non-invasive methods can identify LVO with useful diagnostic performance, while the stronger results for TCD-based approaches may help guide further evaluation. However, variation across studies means these estimates should not be treated as uniform performance in every setting.

What to keep in mind

The review found significant heterogeneity among studies, and the authors call for validation in larger, diverse populations.