Clinical Utility of the Alberta Stroke Program Early CT Score: A Survey Comparing Comprehensive Stroke Centers
Tasha Tombo1, Gabriel Rashba 1, Lora Xu1, Michael Schneck1
1Loyola University Chicago, Stritch School of Medicine
Objective:
Survey ASPECTS use in acute ischemic stroke (AIS) evaluation among United States Comprehensive Stroke Centers (CSC).
Background:
The ASPECTS is used in considering whether patients are appropriate for thrombolysis and/or thrombectomy after AIS. While clinical guidelines recommend ASPECTS evaluations in AIS, we hypothesized ASPECTS use is low in practice. We also explored ASPECTS use between high and low volume CSC.
Design/Methods:
We surveyed US CSC from 2021-2022 regarding ASPECTS utilization in evaluating eligibility for thrombolysis and/or thrombectomy in patients with suspected or confirmed large vessel occlusion. We asked whether ASPECTS was routinely used, if it was the preferred primary modality for final decision making, and whether an ASPECTS <6 excluded a patient from thrombectomy consideration. Survey responses were divided between large (annual volumes of AIS >600) and small CSC (< 600). Chi square analysis was performed.
Results:
Thirty-nine CSC completed the survey. Of these, 21 were large CSC and 18 were small CSC. Of all CSC, 31% did not use ASPECTS at all. Seventy-four percent preferred automated mismatch software over ASPECTS as the primary modality in final decision making. Thirty six percent of CSC noted that an ASPECTS <6 would exclude a patient from consideration for thrombectomy. There was no relationship between CSC size and ASPECTS use [X2 (1, N = 39) = 0.71, p < .05], CSC size and whether ASPECTS was the preferred primary final decision making modality [X2 (1, N = 39) = 0.23, p < .05] or CSC size and whether ASPECTS <6 excluded patients from thrombectomy consideration [X2 (1, N = 39) = 0.73, p < .05].
Conclusions:
In practice, clinical utility of ASPECTS for AIS evaluation is low. Case volume experience has no apparent impact on ASPECTS utilization. Our preliminary survey reveals low use of ASPECTS, and preference for mismatch software in choosing AIS candidates for intervention.