Accuracy of bedside diagnosis in stroke

Area of Science:

• Neurology
• Clinical Diagnostics

Background:

• Clinical diagnosis of acute cerebrovascular diseases is often considered unreliable.
• Prospective validation in representative patient cohorts is lacking.

Purpose of the Study:

• To prospectively evaluate the accuracy of bedside clinical diagnosis for acute cerebrovascular diseases.
• To compare the accuracy of bedside diagnostics with subsequent hospital investigations.

Main Methods:

• Prospective study of 206 consecutively admitted patients to a Stroke Unit.
• Assessment of bedside diagnostic accuracy.
• Comparison of initial clinical diagnosis with diagnoses after hospital investigation.

Main Results:

• Bedside diagnosis was correct in 69% of patients.
• Diagnoses were altered after hospital investigation in 24% of cases.
• Diagnostic accuracy was higher when diagnoses were "fairly certain" (87%) versus "probable" (53%).
• Sensitivity for identifying cerebral hemorrhages (39%) was significantly lower than for cerebral infarctions (83%).
• Diagnostic accuracy improved during the study period.

Conclusions:

• Bedside diagnostic methods for acute cerebrovascular diseases have moderate accuracy.
• There is a need to compare the efficacy of new investigational methods with current bedside approaches.
• Improving diagnostic accuracy for cerebral hemorrhages requires further attention.