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Outcome of patients with large vessel occlusion stroke after first admission in telestroke spoke versus comprehensive stroke center
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  • Published on:
    Regarding: Outcome of patients with large vessel occlusion stroke after first admission in telestroke spoke versus comprehensive stroke center
    • Dag O Sætre, Radiology consultant Østfold Hospital Trust
    • Other Contributors:
      • Geir Mjøen, Resident

    Dear Editor,

    Kaminsky et al1 present an interesting study regarding the logistics of patients eligible for endovascular stroke therapy (EVT). They conclude that whether patients with large vessel occlusion (LVO) are first admitted to a hospital with or without this treatment does not affect patient outcome.
    However, there are some difficulties interpreting the main statistical multivariate analyses. Firstly, although there is a clear presentation of how the main multivariate logistic regression analysis is performed, the covariates included in the model are not presented, and the model is not shown in any table. Secondly, the authors have included variables solely based on the strength of their association with the outcome, and not based on the potential of the variable to confound the relationship between the variable of interest (which center the patient is admitted to first), and the outcome. In this setting, it is our opinion that selecting covariates based on an etiological model, that focuses on the variable of interest, and includes covariates based on the potential for confounding, would be the best strategy.2 We disagree with the authors` choice of a prognostic model.
    We urge the authors to provide a table showing the main analysis, or even repeat the main analysis using an etiological approach to model building and variable selection.
    Despite these shortcomings, we commend the authors for undertaking such a relevant clinical study, and we...

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    Conflict of Interest:
    None declared.