{
  "abstract": "Background Rapid identification of large vessel occlusion (LVO) in acute ischemic stroke (AIS) is essential for reperfusion therapy. Screening tools, including Artificial Intelligence (AI) based algorithms, have been developed to accelerate detection but rely heavily on pre-test LVO prevalence. This study aimed to review LVO prevalence across clinical contexts and analyze its impact on AI-algorithm performance.Methods We systematically reviewed studies reporting consecutive suspected AIS cohorts. Cohorts were grouped into four clinical scenarios based on patient selection criteria: (a) high suspicion of LVO by stroke specialists (direct-to-angiosuite candidates), (b) high suspicion of LVO according to pre-hospital scales, (c) and (d) any suspected AIS without considering severity cut-off in a hospital or pre-hospital setting, respectively. We analyzed LVO prevalence in each scenario and assessed the false discovery rate (FDR) - number of positive studies needed to encounter a false positive, if applying eight commercially available LVO-detecting algorithms.Results We included 87 cohorts from 80 studies. Median LVO prevalence was: (a) 84% (77–87%), (b) 35% (26–42%), (c) 19% (14–25%), and (d) 14% (8–22%). At high prevalence levels: (a) FDR ranged between 0.007 (1 false positive in 142 positives) and 0.023 (1 in 43), whereas in low prevalence scenarios (Ccand d), FDR ranged between 0.168 (1 in 6) and 0.543 (over 1 in 2).Conclusion To ensure meaningful clinical impact, AI algorithms must be evaluated within the specific populations and care pathways where they are applied.",
  "authors": [
    {
      "affiliations": [
        "Stroke Unit, Neurology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain"
      ],
      "name": "Marta Olivé-Gadea"
    },
    {
      "affiliations": [
        "Stroke Unit, Neurology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain"
      ],
      "name": "Jordi Mayol"
    },
    {
      "affiliations": [
        "Stroke Unit, Neurology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain",
        "Interventional Neuroradiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain"
      ],
      "name": "Manuel Requena"
    },
    {
      "affiliations": [
        "Stroke Unit, Neurology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain",
        "Interventional Neuroradiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain"
      ],
      "name": "Marc Rodrigo-Gisbert"
    },
    {
      "affiliations": [
        "Stroke Unit, Neurology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain"
      ],
      "name": "Federica Rizzo"
    },
    {
      "affiliations": [
        "Stroke Unit, Neurology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain"
      ],
      "name": "Alvaro Garcia-Tornel"
    },
    {
      "affiliations": [
        "Stroke Unit, Neurology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain"
      ],
      "name": "Renato Simonetti"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain"
      ],
      "name": "Francesco Diana"
    },
    {
      "affiliations": [
        "Stroke Unit, Neurology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain"
      ],
      "name": "Marian Muchada"
    },
    {
      "affiliations": [
        "Stroke Unit, Neurology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain"
      ],
      "name": "Jorge Pagola"
    },
    {
      "affiliations": [
        "Stroke Unit, Neurology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain"
      ],
      "name": "David Rodriguez-Luna"
    },
    {
      "affiliations": [
        "Stroke Unit, Neurology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain"
      ],
      "name": "Noelia Rodriguez-Villatoro"
    },
    {
      "affiliations": [
        "Stroke Unit, Neurology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain"
      ],
      "name": "Marta Rubiera"
    },
    {
      "affiliations": [
        "Stroke Unit, Neurology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain"
      ],
      "name": "Carlos A Molina"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain"
      ],
      "name": "Alejandro Tomasello"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain"
      ],
      "name": "David Hernandez"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain"
      ],
      "name": "Marta de Dios Lascuevas"
    },
    {
      "affiliations": [
        "Stroke Unit, Neurology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain"
      ],
      "name": "Marc Ribo"
    }
  ],
  "title": "Impact of pre-test probability on AI-LVO detection: a systematic review of LVO prevalence across clinical contexts",
  "uid": "fd0588b7-27d3-551f-b6f0-5fb86ce4ff1c"
}