Table 3.

Included Studies Regarding Alberta Stroke Program Early CT Score and Patient Selection

Category	Reference	Country (Income Status)	Quality Grade	Risk of Bias	Concern for Applicability	Artificial Intelligence Techniques	Key Findings
ASPECTS	Grunwald et al., 201941	Germany, United Kingdom (high)	Moderate	Unclear	Low	NA	Addition of e-CTA improved intraclass correlation coefficient among neuroradiologists Automated e-CTA, without neuroradiologist input, agreed with consensus score in 90% of scans with remaining 10% within 1 point of the consensus Sensitivity of 0.99 and specificity of 0.94 for identifying favorable collateral flow (collateral score 2–3)
	Guberina et al., 201842	Germany (high)	Moderate	Unclear	Low	NA	Higher interrater correlation coefficient of 0.71–0.80 with definite infarct core, compared with 0.59 for ASPECTS in the acute ischemic stroke setting
	Nagel et al., 201650	Canada, Germany, United Kingdom, United States (high)	Moderate	Unclear	Low	NA	Two e-ASPECTS operating points were noninferior to all 3 neuroradiologists Matthews correlation coefficients for e-ASPECTS were higher than those of all neuroradiologists
	Neuhaus et al., 202051	United States, United Kingdom (high)	Moderate	Low	Low	NA	Median ASPECTS was 9 for manual scoring and 8.5 for e-ASPECTS with κ of 0.248 When corrected for the low number of infarcts, κ ranged from 0.483 (insula) to 0.888 (M3), with greater agreement for cortical areas Intraclass correlation coefficients ranged from 0.09 (M1) to 0.556 (lentiform)
Patient Selection	Alawieh et al., 201933	Lebanon, United States (multiple)	Moderate	Low	Low	Regression tree	Sensitivity of 89.4% and specificity of 89.6% with AUC of 0.95 Negative predictive value was >95% Patients who were not selected by algorithm higher rates of symptomatic intracerebral hemorrhage after mechanical thrombectomy
	Wang et al., 202069	United States (high)	Moderate	Low	Low	Convolutional neural network, random forest, support vector machine	Voxel-wise AUC of 0.958, whereas other machine learning algorithms ranged from 0.897 to 0.933 Accuracy of 92%, with a sensitivity of 0.89 and specificity of 0.95, for retrospective determination for subject-level endovascular treatment eligibility Voxel-wise AUC of 0.94 and a subject-level accuracy of 92% for endovascular treatment eligibility

NA, not applicable; CTA, computed tomography angiography; ASPECTS, Alberta Stroke Program Early CT Score; AUC, area under the curve.