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Emergency physician's diagnosis of stroke subtype. An accuracy study
M da M Gomes1, M F Costa, C André
1Hospital Universitário Clementino Fraga Filho, Department of Internal Medicine-Neurology, Faculty of Medicine, Universidade Federal do Rio de Janeiro, Brasil.
Objective:
To evaluate the accuracy of clinical unstructured and structured diagnosis of acute stroke subtypes--cerebral haemorrhage (CH), cerebral infarction (CI), subarachnoid haemorrhage (SAH).
Methods:
Sixty consecutive patients with acute stroke admitted to the Emergency Ward of a Brazilian University Hospital were examined by emergency physicians and computerised tomography (CT). We also compared it (physician's unstructured diagnosis) to two published clinical scoring systems (structured diagnosis--Guy's Hospital and Siriraj Hospital) applied to three other populations--regarding the operational characteristics of the tests.
Results:
In our personal data, among 9 variables that could discriminate CH and CI, three have statistically significant difference (p < 0.05): headache (p = 0.0002) and vomiting (p = 0.02) occurred more frequently in CH patients, but previous stroke in those with CI (p = 0.04). Unstructured diagnosis proved valid for SAH, with a +LHR = 39.7; and to a smaller degree for CI (-LHR = 0.1). However, it exhibited low sensitivity for the diagnosis of CH. Structured tests (Guy's Hospital and Siriraj Hospital) also failed to confidently diagnose stroke subtypes, especially CH.
Conclusions:
Both clinical diagnosis (made by emergency physicians) and the available diagnostic tests fail to confidently discriminate CH and CI.