title: Visual Determination of Conjugate Eye Deviation on Computed Tomography Scan Predicts Diagnosis of Stroke Code Patients.
abstract: BACKGROUND
  Head computed tomography (CT) is critical for stroke code evaluations and often happens prior to completion of the neurological exam. Eye deviation on neuroimaging (DeyeCOM sign) has utility for predicting stroke diagnosis and correlates with National Institutes of Health Stroke Scale (NIHSS) gaze score. We further assessed the utility of the DeyeCOM sign, without complex caliper-based eye deviation calculations, but simply with a visual determination method.
  
  
  METHODS
  Patients with initial head CT and final diagnosis from an institutional review board-approved consecutive prospective registry of stroke codes at the University of California, San Diego, were included. Five stroke specialists and 1 neuroradiologist reviewed each CT. DeyeCOM+ patients were compared to DeyeCOM- patients (baseline characteristics, diagnosis, and NIHSS gaze score). Kappa statistics compared stroke specialists to neuroradiologist reads, and visual determination to caliper measurement of DeyeCOM sign.
  
  
  RESULTS
  Of 181 patients, 46 were DeyeCOM+. Ischemic stroke was more commonly diagnosed in DeyeCOM+ patients compared to other diagnoses (P = .039). DeyeCOM+ patients were more likely to have an NIHSS gaze score of 1 or higher (P = .006). The NIHSS score of DeyeCOM+ stroke versus DeyeCOM- stroke patients was 8.3 ± 6.0 versus 6.7 ± 8.0 (P = .065). Functional outcomes were similar (P = .59). Stroke specialists had excellent agreement with the neuroradiologist (Κ = .89). Visual inspection had excellent agreement with the caliper method (Κ = .88).
  
  
  CONCLUSIONS
  Using a time-sensitive visual determination of gaze deviation on imaging was predictive of ischemic stroke diagnosis and presence of NIHSS gaze score, and was consistent with the more complex caliper method. This study furthers the clinical utility of the DeyeCOM sign for predicting ischemic strokes.
authors: Department of Neurology and Neurologic Sciences, Stanford University, Palo Alto, California. Electronic address: spokoyny@stanford.edu.
authors: Ilana
authors: I
authors: Spokoyny
authors: Department of Radiology, Veterans Administration, San Diego, California; Department of Radiology, University of California, San Diego, California.
authors: James Y
authors: JY
authors: Chen
authors: Department of Family Medicine and Public Health, University of California, San Diego, California; Department of Neurology and Neurologic Sciences, University of California, San Diego, California.
authors: Rema
authors: R
authors: Raman
authors: Department of Family Medicine and Public Health, University of California, San Diego, California.
authors: Karin
authors: K
authors: Ernstrom
authors: Department of Neurology and Neurologic Sciences, University of California, San Diego, California.
authors: Kunal
authors: K
authors: Agrawal
authors: Department of Neurology and Neurologic Sciences, University of California, San Diego, California.
authors: Royya F
authors: RF
authors: Modir
authors: Department of Neurology and Neurologic Sciences, University of California, San Diego, California.
authors: Dawn M
authors: DM
authors: Meyer
authors: Department of Neurology and Neurologic Sciences, University of California, San Diego, California.
authors: Brett C
authors: BC
authors: Meyer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002140:California; D005123:Eye / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005133:Eye Movements; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D015203:Reproducibility of Results; D020521:Stroke / Q000000981:diagnostic imaging* / Q000503:physiopathology; D014057:Tomography, X-Ray Computed
keywords: Stroke; computed tomography; diagnosis; eye deviation; gaze