Cranial computed tomography interpretation in acute stroke: physician accuracy in determining eligibility for thrombolytic therapy.

Abstract

CONTEXT:

Intracranial hemorrhage must be excluded prior to administration of thrombolytic agents in acute stroke.

OBJECTIVE:

To evaluate physician accuracy in cranial computed tomography scan interpretation for determining eligibility for thrombolytic therapy in acute stroke.

DESIGN:

Administration of randomly selected, randomly ordered series of 15 computed tomography scans from a pool of 54 scans that demonstrated intracerebral hemorrhage, acute infarction, intracerebral calcifications (impostor for hemorrhage), old cerebral infarction (impostor for acute infarction), and normal findings.

PARTICIPANTS:

A convenience sample of 38 emergency physicians, 29 neurologists, and 36 general radiologists.

MAIN OUTCOME MEASURES:

Physician determination of eligibility for thrombolytic therapy based on computed tomography scan interpretation.

RESULTS:

Average correct score by all physicians on all computed tomography scans was 77% (95% confidence interval, 74%-80%). Of 569 computed tomography readings by emergency physicians, 67% were correct; of 435 readings by neurologists, 83% were correct; and of 540 readings by radiologists, 83% were correct. Overall sensitivity for detecting hemorrhage was 82% (95% confidence interval, 78%-85%); 17% of emergency physicians, 40% of neurologists, and 52% of radiologists achieved 100% sensitivity for identification of hemorrhage.

CONCLUSION:

Physicians in this study did not uniformly achieve a level of sensitivity for identification of intracerebral hemorrhage sufficient to permit safe selection of candidates for thrombolytic therapy.

• Authors: D L Schriger, M Kalafut, S Starkman, M Krueger, J L Saver
• Journal: JAMA (JAMA) 1998 Apr 22-29 Vol. 279 Issue 16 Pg. 1293-7 ISSN: 0098-7484 [Print] United States
• PMID: 9565011 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Brain (diagnostic imaging)
• Cerebral Hemorrhage (diagnostic imaging)
• Cerebral Infarction (diagnostic imaging)
• Cerebrovascular Disorders (diagnostic imaging, drug therapy)
• Clinical Competence (statistics & numerical data)
• Emergency Medicine (standards)
• Hospitals, University
• Humans
• Logistic Models
• Neurology (standards)
• Patient Selection
• Physicians (standards, statistics & numerical data)
• Radiology (standards)
• Sensitivity and Specificity
• Thrombolytic Therapy
• Tomography, X-Ray Computed
• United States