Revisiting the Endoscopic Third Ventriculostomy Success Score using machine learning: can we do better?

Objective: The Endoscopic Third Ventriculostomy Success Score (ETVSS) is a useful decision-making heuristic when considering the probability of surgical success, defined traditionally as no repeat cerebrospinal fluid diversion surgery needed within 6 months. Nonetheless, the performance of the logistic regression (LR) model in the original 2009 study was modest, with an area under the receiver operating characteristic curve (AUROC) of 0.68.

Improve time to anti-coagulation reversal for hemorrhagic strokes.

Background: Oral anticoagulation (OAC) is a risk factor for intracerebral hemorrhage (ICH) which is an important source of disability and mortality. OAC-associated ICH (OAC-ICH) patients have worse outcomes as compared to ICH patients not on OAC, likely because of the associated larger stroke volumes, higher propensity to intraventricular hemorrhage, and a higher risk of rebleeding. Although current guidelines recommend that OAC should be reversed quickly, many health care systems have not developed a process for optimizing that aspect of care.

Experience with a hybrid recruitment approach of patient-facing web portal screening and subsequent phone and medical record review for a neurosurgical intervention trial for chronic ischemic stroke disability (PISCES III).

Background: Recruitment of participants is the greatest risk to completion of most clinical trials, with 20-40% of trials failing to reach the targeted enrollment. This is particularly true of trials of central nervous system (CNS) therapies such as intervention for chronic stroke. The PISCES III trial was an invasive trial of stereotactically guided intracerebral injection of CTX0E03, a fetal derived neural stem cell line, in patients with chronic disability due to ischemic stroke.

Optimization of a translational murine model of closed-head traumatic brain injury.

Traumatic brain injury (TBI) from closed-head trauma is a leading cause of disability, with limited effective interventions. Many TBI models impact brain parenchyma directly, and are limited by the fact that these forces do not recapitulate clinically relevant closed head injury. However, applying clinically relevant injury mechanics to the intact skull may lead to variability and as a result, preclinical modeling TBI remains a challenge.

Regionalization of stroke systems of care in the stroke belt states: The IMPROVE stroke care quality improvement program.

Background: Despite guidelines and strong evidence supporting intravenous thrombolysis and endovascular thrombectomy for acute stroke, access to these interventions remains a challenge. The objective of the IMPROVE stroke care program was to accelerate acute stroke care delivery by implementing best practices and improving the regional systems of care within comprehensive stroke networks.

Methods: The IMPROVE Stroke Care program was a prospective quality improvement program based on established models used in acute coronary care.