title: Reliability of brain CT evaluation by stroke neurologists in telemedicine.
abstract: OBJECTIVE
  To determine the reliability and therapeutic impact of standardized cerebral CT evaluation and quantification of early ischemic changes (EIC) with the Alberta Stroke Program Early CT Score (ASPECTS) by stroke neurologists in the Stroke Eastern Saxony Network (SOS-NET), which provides telemedical consultations for patients with acute ischemic stroke.
  
  
  METHODS
  Two neuroradiologists re-evaluated all CT scans of consecutive SOS-NET patients in 2009 blinded to clinical information providing reference standard. We defined discrepant CT findings as all false-positive or false-negative EIC and brain pathology findings and ASPECTS deviations >1 point. We subsequently discussed the clinical impact of discrepant CT findings unblinded to clinical information. Weighted kappa (κ(w)) statistic was used to determine the interobserver agreement for ASPECTS.
  
  
  RESULTS
  Of 582 patients, complete imaging data were available for 536 patients (351 cerebral ischemic events, 105 primary intracranial hemorrhages, and 80 stroke mimics). The neuroradiologists detected discrepant CT findings in 43 patients (8.0%) that were rated as clinically relevant in 9 patients (1.7%). Stroke neurologists recommended IV thrombolysis in 8 patients despite extensive EIC (ASPECTS ≤5). One of these patients had symptomatic intracranial hemorrhage. In 1 nonthrombolyzed patient, the stroke neurologist missed subdural hematoma. The interobserver agreement on ASPECTS between stroke neurologists and expert readers was substantial (κ(w) = 0.62; 95% confidence interval 0.54-0.71).
  
  
  CONCLUSIONS
  Clinically relevant misinterpretation of the CT scans was rare in our acute telestroke service. ASPECTS is a reliable tool to assess the extent of EIC by stroke neurologists in telemedicine in real time.
authors.affiliation: Department of Neurology, Dresden University Stroke Center, Dresden, Germany. volker.puetz@uniklinikum-dresden.de
authors.forename: Volker
authors.initials: V
authors.lastname: Puetz
authors.forename: Ulf
authors.initials: U
authors.lastname: Bodechtel
authors.forename: Johannes C
authors.initials: JC
authors.lastname: Gerber
authors.forename: Imanuel
authors.initials: I
authors.lastname: Dzialowski
authors.forename: Alexander
authors.initials: A
authors.lastname: Kunz
authors.forename: Martin
authors.initials: M
authors.lastname: Wolz
authors.forename: Hjoerdis
authors.initials: H
authors.lastname: Hentschel
authors.forename: Thorsten
authors.initials: T
authors.lastname: Schultheiss
authors.forename: Jessica
authors.initials: J
authors.lastname: Kepplinger
authors.forename: Hauke
authors.initials: H
authors.lastname: Schneider
authors.forename: Barbel
authors.initials: B
authors.lastname: Wiedemann
authors.forename: Claudia
authors.initials: C
authors.lastname: Wojciechowski
authors.forename: Heinz
authors.initials: H
authors.lastname: Reichmann
authors.forename: Georg
authors.initials: G
authors.lastname: Gahn
authors.forename: Ruediger
authors.initials: R
authors.lastname: von Kummer
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging*; D042241:Early Diagnosis; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009462:Neurology / Q000592:standards / Q000706:statistics & numerical data; D015588:Observer Variation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging*; D017216:Telemedicine / Q000592:standards* / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed / Q000592:standards* / Q000706:statistics & numerical data