ELECTRA-STROKE: Electroencephalography controlled triage in the ambulance for acute ischemic stroke—Study protocol for a diagnostic trial

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Abstract

Background: Endovascular thrombectomy (EVT) is the standard treatment for large vessel occlusion stroke of the anterior circulation (LVO-a stroke). Approximately half of EVT-eligible patients are initially presented to hospitals that do not offer EVT. Subsequent inter-hospital transfer delays treatment, which negatively affects patients' prognosis. Prehospital identification of patients with LVO-a stroke would allow direct transportation of these patients to an EVT-capable center. Electroencephalography (EEG) may be suitable for this purpose because of its sensitivity to cerebral ischemia. The hypothesis of ELECTRA-STROKE is that dry electrode EEG is feasible for prehospital detection of LVO-a stroke. Methods: ELECTRA-STROKE is an investigator-initiated, diagnostic study. EEG recordings will be performed in patients with a suspected stroke in the ambulance. The primary endpoint is the diagnostic accuracy of the theta/alpha ratio for the diagnosis of LVO-a stroke, expressed by the area under the receiver operating characteristic (ROC) curve. EEG recordings will be performed in 386 patients. Discussion: If EEG can be used to identify LVO-a stroke patients with sufficiently high diagnostic accuracy, it may enable direct routing of these patients to an EVT-capable center, thereby reducing time-to-treatment and improving patient outcomes. Clinical trial registration: ClinicalTrials.gov, identifier: NCT03699397.

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van Stigt, M. N., van de Munckhof, A. A. G. A., van Meenen, L. C. C., Groenendijk, E. A., Theunissen, M., Franschman, G., … Coutinho, J. M. (2022). ELECTRA-STROKE: Electroencephalography controlled triage in the ambulance for acute ischemic stroke—Study protocol for a diagnostic trial. Frontiers in Neurology, 13. https://doi.org/10.3389/fneur.2022.1018493

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