{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T19:44:35Z","timestamp":1791229475592,"version":"4.1.0"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["SVIN"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:sec id=\"svi212928-sec-0010\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Large\u2010vessel occlusion (LVO) ischemic stroke is responsible for significant morbidity and mortality. We have previously described a novel tool for acute LVO detection that combines blood\u2010based biomarkers (glial fibrillary acidic protein and\n              <jats:sc>d<\/jats:sc>\n              \u2010dimer) with stroke severity scales to achieve high accuracy. Accordingly, the present study sought to prospectively validate cutoff values that we had previously established for biomarkers and scales.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec id=\"svi212928-sec-0020\" xml:lang=\"en\">\n            <jats:title>Methods<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              The TIME (Testing for Identification Markers of Stroke) trial was designed as a prospective observational diagnostic accuracy study. All ambulance\u2010identified stroke code activations &lt;18 hours from symptom onset were recruited at Brandon Regional Hospital (Brandon, FL) between May 2021 and August 2022. Previously determined cutoff concentrations of plasma glial fibrillary acidic protein (213\u00a0pg\/mL) and\n              <jats:sc>d<\/jats:sc>\n              \u2010dimer (600\u00a0ng\/mL) were used in combination with prehospital stroke scales to detect LVO. We compared rates of LVO detection against a reference standard using computed tomography\/magnetic resonance angiography.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec id=\"svi212928-sec-0030\" xml:lang=\"en\">\n            <jats:title>Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              A total of 382 patients with suspected stroke were recruited. The final cohort was composed of 323 patients with suspected stroke with the following distribution: LVO ischemic stroke (n = 29, 9%), non\u2010LVO ischemic stroke (n = 48, 15%), hemorrhagic stroke (n = 13, 4%), transient ischemic attack (n = 12, 3.9%), and stroke mimics (n = 220, 68.1%). Combining blood\u2010based biomarkers (glial fibrillary acidic protein and\n              <jats:sc>d<\/jats:sc>\n              \u2010dimer) with the scale field assessment stroke triage for emergency destination yielded the best performance for LVO detection, with specificity of 94% and sensitivity of 71%. Performance was found to be higher in a subanalysis focusing on patients presenting &lt;6 hours from symptom onset, with 93% specificity and 81% sensitivity. Critically, application of the biomarker and stroke scale algorithms ruled out all patients with hemorrhage.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec id=\"svi212928-sec-0040\" xml:lang=\"en\">\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              The present work prospectively validated the potential utility of previously defined glial fibrillary acidic protein and\n              <jats:sc>d<\/jats:sc>\n              \u2010dimer cutoff levels (ie, 213 pg\/mL and 600 ng\/mL, respectively), demonstrating their value for discrimination of LVO stroke from differential diagnoses during code stroke workups. (ClinicalTrials.gov number, NCT04292600.)\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/svin.123.001304","type":"journal-article","created":{"date-parts":[[2024,5,17]],"date-time":"2024-05-17T18:42:51Z","timestamp":1715971371000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":17,"title":["Prospective Validation of Glial Fibrillary Acidic Protein,\n            <scp>d<\/scp>\n            \u2010Dimer, and Clinical Scales for Acute Large\u2010Vessel Occlusion Ischemic Stroke Detection"],"prefix":"10.1161","volume":"4","author":[{"given":"Yasir","family":"Durrani","sequence":"first","affiliation":[{"name":"Brandon Regional Hospital","place":["Brandon"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jakob V. 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