title: Predictors of false-positive stroke thrombectomy transfers.
abstract: BACKGROUND
  Most patients with large vessel occlusion (LVO) stroke need to be transferred to receive thrombectomy. To save time, the decision to transfer often relies on clinical scales as a surrogate for LVO rather than imaging. However, clinical scales have been associated with high levels of diagnostic error. The aim of this study is to define the susceptibility to overdiagnosis of our current transfer decision process by measuring the rate of non-treatment transfers, the most common reasons for no treatment and potential predictors.
  
  
  METHODS
  Clinical and transfer data on consecutive patients transferred to a single endovascular capable centre for possible thrombectomy via stroke code activation were retrospectively reviewed. Whether patients underwent the procedure, why they did not undergo the procedure, and other clinical and logistical predictors were recorded. χ2tests and multivariate logistic regression analysis were performed.
  
  
  RESULTS
  From 2015 to 2016, 105/192 transferred patients (54%) did not undergo thrombectomy and the most common reason was absence of a LVO found on CTA after transfer (71/104 (68%)). 14/16 (88%) with a National Institutes of Health Stroke Scale (NIHSS) score <10 did not undergo thrombectomy while 41/78 (52%) with a NIHSS>20 underwent thrombectomy (p<0.001). Helicopter use was associated with no treatment (p=0.004) while arrival within 5 hours was associated with treatment (p<0.001).
  
  
  CONCLUSIONS
  Clinical scales appear to overdiagnose LVO and may be responsible for the majority of our stroke code transfers not undergoing thrombectomy. Primary stroke centres therefore have reason to develop the capability to rapidly acquire and interpret a CTA in patients with suspected LVO prior to transfer. Such efforts may reduce the costs associated with unnecessary thrombectomy transfers.
authors.affiliation: University of Illinois at Chicago, Chicago, Illinois, USA.
authors.forename: Julia
authors.initials: J
authors.lastname: Yi
authors.affiliation: Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Danielle
authors.initials: D
authors.lastname: Zielinski
authors.affiliation: Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Bichun
authors.initials: B
authors.lastname: Ouyang
authors.affiliation: Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: James
authors.initials: J
authors.lastname: Conners
authors.affiliation: Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Rima
authors.initials: R
authors.lastname: Dafer
authors.affiliation: Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Chen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000601:surgery; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer / Q000379:methods / Q000639:trends*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000601:surgery; D017131:Thrombectomy / Q000379:methods / Q000639:trends*; D016896:Treatment Outcome
keywords: Economics; Intervention; Stroke