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Open Access 01-12-2014 | Study protocol

Prediction of outcome in patients with suspected acute ischaemic stroke with CT perfusion and CT angiography: the Dutch acute stroke trial (DUST) study protocol

Authors: Tom van Seeters, Geert Jan Biessels, Irene C van der Schaaf, Jan Willem Dankbaar, Alexander D Horsch, Merel JA Luitse, Joris M Niesten, Willem PTM Mali, L Jaap Kappelle, Yolanda van der Graaf, Birgitta K Velthuis

Published in: BMC Neurology | Issue 1/2014

Abstract

Background

Prediction of clinical outcome in the acute stage of ischaemic stroke can be difficult when based on patient characteristics, clinical findings and on non-contrast CT. CT perfusion and CT angiography may provide additional prognostic information and guide treatment in the early stage. We present the study protocol of the Dutch acute Stroke Trial (DUST). The DUST aims to assess the prognostic value of CT perfusion and CT angiography in predicting stroke outcome, in addition to patient characteristics and non-contrast CT. For this purpose, individualised prediction models for clinical outcome after stroke based on the best predictors from patient characteristics and CT imaging will be developed and validated.

Methods/design

The DUST is a prospective multi-centre cohort study in 1500 patients with suspected acute ischaemic stroke. All patients undergo non-contrast CT, CT perfusion and CT angiography within 9 hours after onset of the neurological deficits, and, if possible, follow-up imaging after 3 days. The primary outcome is a dichotomised score on the modified Rankin Scale, assessed at 90 days. A score of 0–2 represents good outcome, and a score of 3–6 represents poor outcome. Three logistic regression models will be developed, including patient characteristics and non-contrast CT (model A), with addition of CT angiography (model B), and CT perfusion parameters (model C). Model derivation will be performed in 60% of the study population, and model validation in the remaining 40% of the patients. Additional prognostic value of the models will be determined with the area under the curve (AUC) from the receiver operating characteristic (ROC) curve, calibration plots, assessment of goodness-of-fit, and likelihood ratio tests.

Discussion

This study will provide insight in the added prognostic value of CTP and CTA parameters in outcome prediction of acute stroke patients. The prediction models that will be developed in this study may help guide future treatment decisions in the acute stage of ischaemic stroke.

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The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2377/14/37/prepub

Title: Prediction of outcome in patients with suspected acute ischaemic stroke with CT perfusion and CT angiography: the Dutch acute stroke trial (DUST) study protocol
Authors: Tom van Seeters
Geert Jan Biessels
Irene C van der Schaaf
Jan Willem Dankbaar
Alexander D Horsch
Merel JA Luitse
Joris M Niesten
Willem PTM Mali
L Jaap Kappelle
Yolanda van der Graaf
Birgitta K Velthuis
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: BMC Neurology / Issue 1/2014
Electronic ISSN: 1471-2377
DOI: https://doi.org/10.1186/1471-2377-14-37

At a glance: The STEP trials

Springer Medicine

Prediction of outcome in patients with suspected acute ischaemic stroke with CT perfusion and CT angiography: the Dutch acute stroke trial (DUST) study protocol

Abstract

Background

Methods/design

Discussion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods/design

Discussion

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