Emergency physician's diagnosis of stroke subtype. An accuracy study.
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.
Gomes
M da M
Mda M
Hospital Universitário Clementino Fraga Filho, Department of Internal Medicine-Neurology, Faculty of Medicine, Universidade Federal do Rio de Janeiro, Brasil.
Costa
M F
MF
André
C
C
Gomes
R
R
Novis
S A
SA
D000328:Adult; D000368:Aged; D002543:Cerebral Hemorrhage / Q000175:diagnosis; D002544:Cerebral Infarction / Q000175:diagnosis; D002561:Cerebrovascular Disorders / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis; D014057:Tomography, X-Ray Computed