{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T15:29:04Z","timestamp":1788449344704,"version":"build-2803163510"},"reference-count":38,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2024,4,21]],"date-time":"2024-04-21T00:00:00Z","timestamp":1713657600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Large\u2010vessel occlusion (LVO) stroke represents one\u2010third of acute ischemic stroke (AIS) in the United States but causes two\u2010thirds of poststroke dependence and &gt;90% of poststroke mortality. Prehospital LVO stroke detection permits efficient emergency medical systems (EMS) transport to an endovascular thrombectomy (EVT)\u2010capable center. Our primary objective was to determine the feasibility of using a cranial accelerometry (CA) headset device for prehospital LVO stroke detection. Our secondary objective was development of an algorithm capable of distinguishing LVO stroke from other conditions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We prospectively enrolled consecutive adult patients suspected of acute stroke from 11 study hospitals in four different U.S. geographical regions over a 21\u2010month period. Patients received device placement by prehospital EMS personnel. Headset data were matched with clinical data following informed consent. LVO stroke diagnosis was determined by medical chart review. The device was trained using device data and Los Angeles Motor Scale (LAMS) examination components. A binary threshold was selected for comparison of device performance to LAMS scores.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 594 subjects were enrolled, including 183 subjects who received the second\u2010generation device. Usable data were captured in 158 patients (86.3%). Study subjects were 53% female and 56% Black\/African American, with median age 69\u2009years. Twenty\u2010six (16.4%) patients had LVO and 132 (83.6%) were not LVO (not\u2010LVO AIS, 33; intracerebral hemorrhage, nine; stroke mimics, 90). COVID\u201019 testing and positivity rates (10.6%) were not different between groups. We found a sensitivity of 38.5% and specificity of 82.7% for LAMS\u2009\u2265\u20094 in detecting LVO stroke versus a sensitivity of 84.6% (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0015 for superiority) and specificity of 82.6% (<jats:italic>p<\/jats:italic>\u2009=\u20090.81 for superiority) for the device algorithm (CA\u2009+\u2009LAMS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Obtaining adequate recordings with a CA headset is highly feasible in the prehospital environment. Use of the device algorithm incorporating both CA and LAMS data for LVO detection resulted in significantly higher sensitivity without reduced specificity when compared to the use of LAMS alone.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.14919","type":"journal-article","created":{"date-parts":[[2024,4,21]],"date-time":"2024-04-21T15:00:05Z","timestamp":1713711605000},"page":"848-859","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Headpulse measurement can reliably identify large\u2010vessel occlusion stroke in prehospital suspected stroke patients: Results from the EPISODE\u2010PS\u2010COVID study"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2154-4472","authenticated-orcid":false,"given":"James H.","family":"Paxton","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Wayne State University School of Medicine  Detroit Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin J.","family":"Keenan","sequence":"additional","affiliation":[{"name":"Department of Neurology University of California, Davis  Sacramento California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John M.","family":"Wilburn","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Wayne State University School of Medicine  Detroit Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefanie L.","family":"Wise","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Wayne State University School of Medicine  Detroit Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard A.","family":"Klausner","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Wayne State University School of Medicine  Detroit Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew T.","family":"Ball","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Wayne State University School of Medicine  Detroit Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert B.","family":"Dunne","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Wayne State University School of Medicine  Detroit Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. Derek","family":"Kreitel","sequence":"additional","affiliation":[{"name":"Department of Radiology Western Michigan University Homer Stryker MD School of Medicine  Kalamazoo Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larry F.","family":"Morgan","sequence":"additional","affiliation":[{"name":"Department of Medicine Western Michigan University Homer Stryker MD School of Medicine  Kalamazoo Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William D.","family":"Fales","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Western Michigan University Homer Stryker MD School of Medicine  Kalamazoo Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0694-9690","authenticated-orcid":false,"given":"Debbie","family":"Madhok","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobl","family":"Barazangi","sequence":"additional","affiliation":[{"name":"Department of Neurology California Pacific Medical Center  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven T.","family":"McLean","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Ascension St. Mary's Hospital  Saginaw Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Cross","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Wayne State University School of Medicine  Detroit Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Distenfield","sequence":"additional","affiliation":[{"name":"MindRhythm, Inc.  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