VALIDATE—Utilization of the Viz.ai mobile stroke care coordination platform to limit delays in LVO stroke diagnosis and endovascular treatment

Thomas Devlin, Lan Gao, Oleg Collins, Gregory W Heath, Morgan Figurelle, Amanda Avila, Caitlyn Boyd, Hira Ayub, Theresa Sevilis
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Abstract

Thousands of hospitals worldwide have adopted mobile artificial intelligence (AI)-based stroke care coordination platforms. Studies exploring the benefit of these platforms have been scrutinized due to small sample size, serial cohort design, and measurement of metrics with multiple determinants. In this large multi-center study, we evaluated the ability of an AI-based stroke care coordination platform to expedite contact with the interventionalist (NIR) for potential thrombectomy.Acute stroke consultations seen by TeleSpecialists, LLC physicians at 166 facilities (17 states) utilizing Viz.ai software (AI) vs. no AI software (non-AI) were extracted from the TeleCare by TeleSpecialists™ database from December 1, 2021, through March 31, 2022. The primary outcome was time from patient arrival to first contact with the interventionalist to discuss need for potential thrombectomy (Arrival-to-NIR notification).A total of 14,116 cases were analyzed. Compared to the non-AI cohort, Arrival-to-NIR notification in the AI cohort was: (1) 39.5 min faster (44.13% reduction, p < 0.001) in the overall analysis; (2) 33.0 min faster (34.0% reduction, p < 0.001) in the non-thrombectomy (non-TC) facility subgroup analysis; and (3) 34.0 min faster (43.59% reduction, p < 0.001) in the thrombectomy capable (TC) facility subgroup analysis. IQR range comparison demonstrated a significant improvement in uniformity of stroke workflow across all AI subgroups. Significant, albeit small, confounding biases were revealed in the data. The presence of AI within the non-TC subgroup correlated with a lower acceptance rate for thrombectomy by the NIR (delta = −10.79% absolute and 23.17% relative reduction, p < 0.0001).While this study was limited by our inability to capture detailed neuroimaging timelines and patient outcomes, it suggests a potential significant benefit of AI-based stroke care coordination platforms and underscores the critical need to development robust “big data” systems to study the effects of AI, and other emerging technologies, on stroke systems of care.
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VALIDATE-利用 Viz.ai 移动中风护理协调平台减少 LVO 中风诊断和血管内治疗的延误
全球已有数千家医院采用了基于移动人工智能(AI)的卒中护理协调平台。由于样本量小、序列队列设计以及测量指标具有多重决定因素,探索这些平台益处的研究受到了严格的审查。在这项大型多中心研究中,我们评估了基于人工智能的中风护理协调平台加快与介入医师(NIR)联系以进行潜在血栓切除术的能力。从 TeleCare by TeleSpecialists™ 数据库中提取了 2021 年 12 月 1 日至 2022 年 3 月 31 日期间 TeleSpecialists, LLC 医生在 166 家机构(17 个州)使用 Viz.ai 软件(人工智能)与未使用人工智能软件(非人工智能)进行急性中风会诊的数据。主要结果是从患者到达到首次与介入专家联系讨论是否需要进行血栓切除术的时间(到达到近红外通知)。与非人工智能队列相比,人工智能队列的到达到近红外通知时间:(1) 在总体分析中快了 39.5 分钟(缩短了 44.13%,p < 0.001);(2) 在非血栓切除术(non-thrombectomy,non-TC)设施亚组分析中快了 33.0 分钟(缩短了 34.0%,p < 0.001);(3) 在有血栓切除术能力(thrombectomy capable,TC)设施亚组分析中快了 34.0 分钟(缩短了 43.59%,p < 0.001)。IQR 范围比较显示,所有人工智能亚组的卒中工作流程一致性都有显著改善。数据中发现了明显的混杂偏差,尽管偏差很小。虽然这项研究受限于我们无法捕捉到详细的神经影像学时间表和患者预后,但它表明基于人工智能的卒中护理协调平台具有潜在的重大优势,并强调了开发强大的 "大数据 "系统以研究人工智能和其他新兴技术对卒中护理系统的影响的迫切需要。
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