Diagnostic value of non-invasive large vessel occlusion detection methods: A systematic review and meta-analysis

BackgroundAccurate and timely prehospital detection of large vessel occlusion (LVO) is critical for optimizing patient triage and initiating appropriate reperfusion therapies. Recent advances in portable stroke detection technologies, such as electroencephalography (EEG) and transcranial Doppler (TCD) ultrasound, offer potential solutions but their diagnostic performance remains unclear.MethodsWe searched PubMed, Scopus, Embase, and Web of Science, following the PRISMA guidelines. Studies were included if they assessed the diagnostic performance of non-invasive prehospital LVO detection tools compared to CT or MR angiography. Risk of bias was assessed using the QUADAS-2 tool.ResultsA total of 13 studies were included, examining various portable detection tools including EEG or neurophysiological monitoring, ultrasound-based techniques including TCD or TCCD, portable Openwater optical blood flow monitor and cranial accelerometry. The pooled diagnostic odds ratio (DOR) was 52.7 (95% CI: 28.3-97.8), indicating strong diagnostic performance, with significant heterogeneity among studies (I² = 67.3%, P < 0.001). Subgroup analysis revealed that TCD-based methods had the highest DOR (120.4, 95% CI: 76.9-188.7), followed by other tools (26.8, 95% CI: 13.7-52.6), and EEG (18.2, 95% CI: 9.1-36.3). The pooled sensitivity was 87.4% (95% CI: 82.5-91.0) and specificity was 89.39% (95% CI: 83.0-93.5) across all methods. TCD-based methods showed the highest specificity (95.0%, 95% CI: 91.8-97.0).ConclusionNon-invasive prehospital LVO detection tools show promising diagnostic performance, particularly TCD-based methods. Future studies should focus on validating these tools in larger, diverse populations to enhance prehospital stroke triage and improve patient outcomes.