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Laci Costa

How High-Performance Clinical AI Helps Institutions Meet AHA/ASA Guidelines for Intracerebral Hemorrhage Standardization

aiOS, Intracranial Hemorrhage, Orchestration, Triage, Workflow
Table of Contents

The management of Intracerebral Hemorrhage (ICH) — a condition responsible for significant functional disability and a 30% to 40% mortality rate1 — has long lagged behind that of ischemic stroke. This is changing.

The publication of the 2024 AHA/ASA Performance and Quality Measures for Spontaneous ICH marks a crucial pivot. These measures are designed to drive standardization, reduce variability and ensure patients receive high-quality, evidence-based care across the entire spectrum, from prehospital to posthospital settings.

For hospitals striving to meet this elevated standard, the question is simple: How reliable is the technology that initiates the entire life-saving protocol for patients with ICH?

The New Standard: Why High-Fidelity Triage Is Non-Negotiable

The core of the American Heart Association (AHA)/American Stroke Association (ASA) initiative is the principle that “You can’t improve what you don’t measure”. The new measures place a heavy emphasis on rapid action:

  1. Rapid Neuroimaging: Patients with acute spontaneous ICH must receive a brain CT or MRI within 25 minutes of arrival to the hospital. This aligns with current ischemic stroke guidelines.
  2. Anticoagulant Reversal: For anticoagulated patients, appropriate reversal must be initiated within 90 minutes of ED arrival to limit hematoma expansion (HE).
  3. Time-to-BP Target: A quality measure aimed at piloting rapid blood pressure (BP) lowering within one hour of hospital arrival and reaching the target within two hours.

These aggressive time goals mean that the moment an ICH is confirmed on imaging is the instant the clock starts ticking for multiple critical, time-sensitive interventions. Said another way, high-fidelity triage is simply non-negotiable.

The Evidence: Conventional AI Performance Gaps Compromise Protocol

A recently published head-to-head study in the American Journal of Neuroradiology (AJNR) comparing two commercially available ICH AI triage solutions within a single academic institution, highlights why only some of the available technologies can reliably support the AHA/ASA mission.

The study, comparing Aidoc (Vendor A) to a Conventional AI solution (Vendor B) on over 4,000 NCHCT scans, shows a dramatic clinical difference:

  • Aidoc Sensitivity (Vendor A): 94.4%; Specificity: 97.4%
  • Conventional AI Sensitivity (Vendor B): 59.5%; Specificity: 99.0%

What This Means for Standardization:

  1. Maximized Awareness: Aidoc’s high sensitivity ensures increased disease awareness for critical time-sensitive cases. This superior performance is foundational for initiating and accelerating the standardized 90-minute reversal protocol.
  2. Minimized False Negatives (FNs): The Conventional AI solution recorded 145 False Negatives, largely missing subdural and subarachnoid hemorrhages. Aidoc recorded just 20 FNs. Low-fidelity performance like that shown in the Conventional AI solution compromises data integrity and undercuts confidence in the system designed to prevent poor outcomes.

Aidoc’s Solution: Orchestrating the Standard of Care

The findings of the head-to-head study and the goals of the AHA/ASA guidelines confirm that technology is only as effective as the workflow it supports. AI solutions do not fix broken systems; they require protocols and workflows to be adapted and standardized to realize their full potential.

Aidoc’s platform is designed to be the foundational tool for this adaptation by delivering the high-fidelity performance needed to support the suggested measures:

  • Accelerated Triage: Our AI ICH algorithm automatically processes the NCHCT immediately upon image acquisition, driving prioritization to ensure the neuroradiologist sees the case as quickly as possible, directly supporting the goal of Rapid Neuroimaging.
  • Clinical Orchestration: Aidoc’s aiOS™ platform unifies suspected critical neuro findings — including ICH, vessel occlusions and brain aneurysms — and ensures the entire multidisciplinary team, from ED to Neurosurgery, is instantly notified. This reliable trigger is essential for meeting the time-critical Anticoagulant Reversal and facilitating Time-to-BP Target.

When paired with a hospital’s commitment to implementing and measuring these protocols, a high-performance AI like Aidoc’s is the most powerful tool for achieving the quality improvement and better patient outcomes defined by the AHA/ASA.

Learn more about Aidoc’s neuro AI solutions.

Citations

  1. Flaherty ML, Haverbusch M, Sekar P, Kissela B, Kleindorfer D, Moomaw CJ, Sauerbeck L, Schneider A, Broderick JP, Woo D. Long-term mortality after intracerebral hemorrhage. Neurology. 2006;66:1182–1186. doi: 10.1212/01.wnl.0000208400.08722.7c

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Laci Costa
Laci Costa is the Senior Director of Neurovascular Product Marketing at Aidoc. She leads marketing and commercial strategy for the neuro AI portfolio of products. She has 16 years of experience working in the medical device and healthcare industry, with over 12 years dedicated to neurovascular solutions. Costa's known for her expertise in the neurovascular industry, go-to-market experience with new technologies and upstream and downstream product marketing leadership. She's held various leadership positions in product marketing, clinical education and professional affairs spanning across start-up organizations to large publicly traded companies. Costa holds a bachelor’s degree in psychology from the University of Oklahoma and an MBA from USC Marshall School of Business.
Laci Costa
Senior Director, Neurovascular Product Marketing

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