Stroke remains a devastating condition, ranking as a leading cause of both morbidity and mortality worldwide. The urgency in stroke care stems from the critical need for rapid diagnosis and treatment. Delays in diagnosis can significantly worsen patient outcomes. Traditional diagnostic methods, primarily CT and MRI scans, while effective, can be time-consuming, especially in prehospital or resource-limited settings. This has spurred the development of innovative point-of-care diagnostic technologies aimed at accelerating stroke diagnosis and improving patient care. But is there a need for point-of-care stroke diagnosis? The answer, supported by recent research, is a resounding yes.
The quest for faster and more accessible stroke diagnosis has led to the exploration of various next-generation technologies. A comprehensive systematic review analyzed studies from the last decade focusing on noninvasive point-of-care stroke diagnostic tools. This review, adhering to rigorous PRISMA guidelines and employing the QUADAS-2 tool for bias assessment, examined research from PubMed, Web of Science, and Scopus databases. The key metrics evaluated included diagnostic accuracy, speed compared to standard imaging, potential risks, limitations, cost-effectiveness, portability, and detection range.
The findings of this review, encompassing 19 studies out of an initial pool of 2646 articles, highlight the promise of several point-of-care modalities for stroke detection. Microwave technology emerged as a prominent area of research, featuring in 6 studies (31.6%). These devices showed an AUC of 0.88 in differentiating between ischemic stroke and intracerebral hemorrhage (ICH), demonstrating significant potential for rapid stroke subtyping. Electroencephalography (EEG) based diagnostics were also notable, appearing in 4 studies (21.1%), achieving a maximum sensitivity of 91.7% for stroke prediction. This high sensitivity suggests EEG’s capability to effectively rule out stroke in point-of-care settings.
Other technologies investigated include ultrasonography (3 studies, 15.8%), which achieved an impressive AUC of 0.92 in diagnostic accuracy. Volumetric Impedance Phase-Shift Spectroscopy (VIPS), while featured in only one study (5.3%), demonstrated a high AUC of 0.93. Portable MRI devices, explored in 2 studies (10.5%), showed diagnostic accuracy comparable to traditional MRI, albeit with the advantage of portability. Near-infrared spectroscopy (NIRS) (2 studies, 10.5%) presents a valuable tool for detecting superficial hemorrhages but faces limitations in deeper ICH detection due to its 2.5-cm scanning depth. Finally, eddy current damping (1 study, 5.3%) represents another novel approach under investigation.
In conclusion, the advancements in technology and computational power have paved the way for the development of promising point-of-care medical devices for stroke diagnosis. These technologies offer the potential to significantly reduce the time to diagnosis, a critical factor in stroke treatment and outcomes. By facilitating rapid stroke diagnosis, point-of-care devices can play a crucial role in improving time to treatment and optimizing prehospital stroke triage, ultimately addressing the pressing need for faster and more accessible stroke diagnostics and improving patient outcomes.
