AUTHOR=van Stigt Maritta N. , van de Munckhof Anita A. G. A. , van Meenen Laura C. C. , Groenendijk Eva A. , Theunissen Monique , Franschman Gaby , Smeekes Martin D. , van Grondelle Joffry A. F. , Geuzebroek Geertje , Siegers Arjen , Marquering Henk A. , Majoie Charles B. L. M. , Roos Yvo B. W. E. M. , Koelman Johannes H. T. M. , Potters Wouter V. , Coutinho Jonathan M. 

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

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.1018493

DOI=10.3389/fneur.2022.1018493

ISSN=1664-2295

ABSTRACT=Background:
Endovascular thrombectomy (EVT) is 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 LVO-a stroke patients 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 are performed in patients with a suspected stroke in the ambulance. The primary endpoint is the diagnostic accuracy of the theta/alpha ratio for diagnosis of LVO-a stroke, expressed by the area under the receiver operating characteristics 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.

Trial registration: 
ClinicalTrials.gov identifier (NCT number): NCT03699397; 9 October 2018. https://clinicaltrials.gov/ct2/show/NCT03699397