Fig 1.
The recruitment of participants into the study and final analysis.
Fig 2.
Transcranial colour-coded sonography findings in a patient with a massive right middle cerebral artery territory infarct.
Absent flow in the middle cerebral artery and reversed flow in the ipsilateral anterior cerebral artery (A) when compared to the flow within the vessels on the unaffected side (B). Long white arrow indicates blood flow within the middle cerebral artery and short white arrow indicates blood flow within the anterior cerebral artery.
Fig 3.
Brain imaging findings in a patient with acute intracerebral haemorrhage.
CT brain scan (A) and transcranial ultrasound (B) showing a 12 mm haemorrhagic lesion in the right basal ganglia.
Table 1.
Comparison of baseline characteristics between the patient groups.
Fig 4.
Diagnostic accuracy of transcranial ultrasonography in suspected acute stroke patients (modified STARD 2015 flow diagram).
Abbreviations: LVO—large vessel occlusion; TIA—transient ischaemic attack.
Fig 5.
Receiver operating characteristics plots with diagonal reference line (red) demonstrating diagnostic accuracy of the regression models for diagnosis of acute haemorrhagic stroke.
(A) based on combined transcranial ultrasound and clinical assessment, versus (B) based on clinical findings alone. Red asterisks indicate two possible cut-off points. Abbreviations: AUC—area under the curve; CI—confidence interval.
Table 2.
Diagnostic accuracy of the prognostic model for diagnosis of intracranial haemorrhage.
Table 3.
Ordinal logistic regression model for diagnosis of acute ischaemic stroke with probable LVO, acute stroke with no evidence of LVO, and non-strokes based on transcranial ultrasound and clinical variables.
Fig 6.
Receiver operating characteristics plots with diagonal reference line (red) demonstrating diagnostic accuracy of the regression models for diagnosis of acute ischaemic stroke due to LVO.
(A) based on combined transcranial ultrasound and clinical assessment, versus (B) based on clinical findings alone. Abbreviations: AUC—area under the curve; CI—confidence interval; LVO—large vessel occlusion.
Table 4.
Diagnostic accuracy of the prognostic model for diagnosis of acute ischaemic stroke due to LVO based on combined transcranial ultrasound and clinical assessment versus clinical findings alone.
Fig 7.
Tentative “TUCA” model for pre-hospital triage of suspected stroke patients based on transcranial ultrasound and clinical assessment for remote and rural communities.
According to the current guidelines in the UK IV tPA can be given within 4.5 hours of stroke symptom onset. Mechanical thrombectomy can be performed within 6 hours of the onset of stroke symptoms; an extended time window of 6 to 24 hours from the time the patient was last known to be well can be offered in selected cases. Abbreviations: AF—atrial fibrillation; ECG—electrocardiography; ICH—intracranial haemorrhage; IV tPA—intravenous thrombolysis with tissue plasminogen activator; LMWH—low molecular weight heparin; LVO—large vessel occlusion; SBP—systolic blood pressure (mmHg).