A clinical-AI correlation for integrating artificial intelligence into stroke care: a systematized literature review...

The rapid integration of artificial intelligence (AI) into stroke care has outpaced many clinicians' ability to critically evaluate and safely implement these tools. We conducted a systematized literature review and developed a practical framework to guide neurologists in the responsible integration of AI into stroke practice.

We performed a systematized review of PubMed, EMBASE, and gray literature (January 2018-June 2025) following adapted PRISMA guidelines. Search strategies combined AI-related terms with stroke care concepts. We assessed risk of bias using QUADAS-2, RoB 2, and ROBINS-I tools. Expert consultation with stroke neurologists and AI developers informed framework development.

From 8,635 identified records, 152 studies met inclusion criteria (47 in quantitative synthesis). AI applications spanned large vessel occlusion detection (30 %), ASPECTS scoring (21 %), outcome prediction (18 %), hemorrhage detection (15 %), and treatment selection (16 %). Only 23% of studies showed low risk of bias, with main concerns including selection bias (29 %), confounding (38 %), and limited external validation (8 % prospective validation). The Clinical-AI Correlation Framework emphasizes three pillars: (1) problem identification and tool selection, (2) clinical correlation using Bayesian reasoning and topographic pattern recognition, and (3) continuous feedback and quality improvement.

Safe AI integration in stroke care requires structured clinical correlation, robust governance frameworks, and continuous monitoring. Our framework provides practical guidance for maintaining clinical judgment while leveraging AI capabilities, emphasizing human oversight for high-risk decisions and systematic documentation of AI-clinician interactions.