Thank you for your interest in our manuscript.1 ,2 Real world studies are critical in understanding the limitations and performance of these software packages and how they perform in different environments. This facilitates generalizability to the users' unique settings and use case. On review of the studies you have cited, we found that many of them have findings similar to our study.1 In our retrospective performance analysis, Rapid large vessel occlusion (LVO) had a specificity of 0.85 and a sensitivity of 0.87, with a positive predictive value of 0.46 and a negative predictive value of 0.97. Viz LVO had a specificity of 0.96 and a sensitivity of 0.87, with a positive predictive value of 0.75 and a negative predictive value of 0.98. This is consistent with previous studies, including some of the studies cited in your letter. According to Soun et al, Rapid LVO had a sensitivity of 0.96, specificity of 0.85, negative predictive value of 0.99, and positive predictive value of 0.53.3 Schlossman et al showed that Rapid LVO demonstrated a sensitivity of 0.90, specificity of 0.86, positive predictive value of 0.45, and negative predictive value of 0.98.4 The studies cited in your letter show values very similar to those we have reported and are reassuring with respect to the validity of our findings.

In your letter, you present an average of the values for sensitivity, specificity, positive predictive value, and negative predictive value. Taking three …