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The accuracy of prehospital diagnosis of acute cerebrovascular accidents: an observational study.

Karliński M, Gluszkiewicz M, Członkowska A - Arch Med Sci (2015)

Bottom Line: Misdiagnoses were less frequent among ambulance physicians compared to primary care and outpatient physicians (33% vs. 52%, p < 0.001).The most frequent mimics were vertigo (19%), electrolyte and metabolic disturbances (12%), seizures (11%), cardiovascular disorders (10%), blood hypertension (8%) and brain tumors (5%).Additionally, 6% of all admitted CVA cases were referred with prehospital diagnoses other than CVA.

View Article: PubMed Central - PubMed

Affiliation: 2 Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland.

ABSTRACT

Introduction: Time to treatment is the key factor in stroke care. Although the initial medical assessment is usually made by a non-neurologist or a paramedic, it should ensure correct identification of all acute cerebrovascular accidents (CVAs). Our aim was to evaluate the accuracy of the physician-made prehospital diagnosis of acute CVA in patients referred directly to the neurological emergency department (ED), and to identify conditions mimicking CVAs.

Material and methods: This observational study included consecutive patients referred to our neurological ED by emergency physicians with a suspicion of CVA (acute stroke, transient ischemic attack (TIA) or a syndrome-based diagnosis) during 12 months. Referrals were considered correct if the prehospital diagnosis of CVA proved to be stroke or TIA.

Results: The prehospital diagnosis of CVA was correct in 360 of 570 cases. Its positive predictive value ranged from 100% for the syndrome-based diagnosis, through 70% for stroke, to 34% for TIA. Misdiagnoses were less frequent among ambulance physicians compared to primary care and outpatient physicians (33% vs. 52%, p < 0.001). The most frequent mimics were vertigo (19%), electrolyte and metabolic disturbances (12%), seizures (11%), cardiovascular disorders (10%), blood hypertension (8%) and brain tumors (5%). Additionally, 6% of all admitted CVA cases were referred with prehospital diagnoses other than CVA.

Conclusions: Emergency physicians appear to be sensitive in diagnosing CVAs but their overall accuracy does not seem high. They tend to overuse the diagnosis of TIA. Constant education and adoption of stroke screening scales may be beneficial for emergency care systems based both on physicians and on paramedics.

No MeSH data available.


Related in: MedlinePlus

Structure of admissions to the department and referrals suspected of acute cerebrovascular accident (CVA) during the study period
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Figure 0001: Structure of admissions to the department and referrals suspected of acute cerebrovascular accident (CVA) during the study period

Mentions: During the 12-month study period there were 570 referrals with a prehospital diagnosis of CVA (Figure 1). Patients were most frequently suspected of stroke (60.9%) or TIA (28.2%). The remaining 10.9% had a descriptive diagnosis classified as CVA (e.g. unilateral weakness or aphasia of abrupt onset) (Table I).


The accuracy of prehospital diagnosis of acute cerebrovascular accidents: an observational study.

Karliński M, Gluszkiewicz M, Członkowska A - Arch Med Sci (2015)

Structure of admissions to the department and referrals suspected of acute cerebrovascular accident (CVA) during the study period
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4495149&req=5

Figure 0001: Structure of admissions to the department and referrals suspected of acute cerebrovascular accident (CVA) during the study period
Mentions: During the 12-month study period there were 570 referrals with a prehospital diagnosis of CVA (Figure 1). Patients were most frequently suspected of stroke (60.9%) or TIA (28.2%). The remaining 10.9% had a descriptive diagnosis classified as CVA (e.g. unilateral weakness or aphasia of abrupt onset) (Table I).

Bottom Line: Misdiagnoses were less frequent among ambulance physicians compared to primary care and outpatient physicians (33% vs. 52%, p < 0.001).The most frequent mimics were vertigo (19%), electrolyte and metabolic disturbances (12%), seizures (11%), cardiovascular disorders (10%), blood hypertension (8%) and brain tumors (5%).Additionally, 6% of all admitted CVA cases were referred with prehospital diagnoses other than CVA.

View Article: PubMed Central - PubMed

Affiliation: 2 Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland.

ABSTRACT

Introduction: Time to treatment is the key factor in stroke care. Although the initial medical assessment is usually made by a non-neurologist or a paramedic, it should ensure correct identification of all acute cerebrovascular accidents (CVAs). Our aim was to evaluate the accuracy of the physician-made prehospital diagnosis of acute CVA in patients referred directly to the neurological emergency department (ED), and to identify conditions mimicking CVAs.

Material and methods: This observational study included consecutive patients referred to our neurological ED by emergency physicians with a suspicion of CVA (acute stroke, transient ischemic attack (TIA) or a syndrome-based diagnosis) during 12 months. Referrals were considered correct if the prehospital diagnosis of CVA proved to be stroke or TIA.

Results: The prehospital diagnosis of CVA was correct in 360 of 570 cases. Its positive predictive value ranged from 100% for the syndrome-based diagnosis, through 70% for stroke, to 34% for TIA. Misdiagnoses were less frequent among ambulance physicians compared to primary care and outpatient physicians (33% vs. 52%, p < 0.001). The most frequent mimics were vertigo (19%), electrolyte and metabolic disturbances (12%), seizures (11%), cardiovascular disorders (10%), blood hypertension (8%) and brain tumors (5%). Additionally, 6% of all admitted CVA cases were referred with prehospital diagnoses other than CVA.

Conclusions: Emergency physicians appear to be sensitive in diagnosing CVAs but their overall accuracy does not seem high. They tend to overuse the diagnosis of TIA. Constant education and adoption of stroke screening scales may be beneficial for emergency care systems based both on physicians and on paramedics.

No MeSH data available.


Related in: MedlinePlus