title: Telemedical Brain Computed Tomography Misinterpretation by Stroke Neurologists Is Not Associated with Thrombolysis-Related Intracranial Hemorrhage.
abstract: BACKGROUND
  The Stroke Eastern Saxony Network (SOS-NET) provides telecare for acute stroke patients. Stroke neurologists recommend intravenous thrombolysis based on clinical assessment and cerebral computed tomography (CT) evaluation using Alberta Stroke Program Early CT score (ASPECTS). We sought to assess whether ASPECTS misinterpretation by stroke neurologists was associated with thrombolysis-related symptomatic intracranial hemorrhage (sICH).
  
  
  METHODS
  We retrospectively analyzed consecutive SOS-NET patients treated with thrombolytics from July 2007 to July 2012. Experienced neuroradiologists re-evaluated CT scans blinded to clinical information providing reference standard. We defined ASPECTS underestimation as ASPECTS stroke neurologist--ASPECTS neuroradiologist more than 1 point. Primary outcome was sICH by European Cooperative Acute Stroke Study II criteria. Secondary outcome was unfavorable outcome at discharge defined as modified Rankin Scale scores 3 or more.
  
  
  RESULTS
  Of 1659 patients with acute ischemic stroke, thrombolysis was performed in 657 patients. Complete primary outcome and imaging data were available for 432 patients (median age, 75; interquartile range [IQR], 12 years; National Institutes of Health Stroke Scale score, 12 [IQR, 11]; 52.8% women). Nineteen patients (4.4%) had sICH, and 259 patients (60.0%) had an unfavorable outcome at discharge. Interobserver agreement between ASPECTS assessment was fair (κ = .51). ASPECTS underestimation was neither associated with sICH (adjusted odds ratio (OR), 1.32; 95% confidence interval (CI), .36-4.83, P = .68) nor unfavorable outcome (adjusted OR, 1.10; 95% CI, .47-2.54; P = .83).
  
  
  CONCLUSIONS
  Despite fair interrater agreement between stroke neurologists and expert neuroradiologists, underestimation of ASPECTS by the former was not associated with thrombolysis-related sICH in our telestroke network.
authors: Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany. Electronic address: Charlotte.Zerna@uniklinikum-dresden.de.
authors: Charlotte
authors: C
authors: Zerna
authors: Division of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany.
authors: Ruediger
authors: R
authors: von Kummer
authors: Division of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany.
authors: Johannes
authors: J
authors: Gerber
authors: Division of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany.
authors: Kai
authors: K
authors: Engellandt
authors: Division of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany.
authors: Andrij
authors: A
authors: Abramyuk
authors: Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany.
authors: Claudia
authors: C
authors: Wojciechowski
authors: Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany.
authors: Kristian
authors: K
authors: Barlinn
authors: Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany.
authors: Jessica
authors: J
authors: Kepplinger
authors: Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany.
authors: Lars-Peder
authors: LP
authors: Pallesen
authors: Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany.
authors: Timo
authors: T
authors: Siepmann
authors: Department of Neurology, Elblandklinikum Meissen, Meissen, Germany.
authors: Imanuel
authors: I
authors: Dzialowski
authors: Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany.
authors: Heinz
authors: H
authors: Reichmann
authors: Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany.
authors: Volker
authors: V
authors: Puetz
authors: Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany.
authors: Ulf
authors: U
authors: Bodechtel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002983:Clinical Competence; D003951:Diagnostic Errors; D004185:Disability Evaluation; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007262:Infusions, Intravenous; D020300:Intracranial Hemorrhages / Q000139:chemically induced*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015588:Observer Variation; D016017:Odds Ratio; D011237:Predictive Value of Tests; D020127:Recovery of Function; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000503:physiopathology; D019113:Telepathology / Q000379:methods*; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents
keywords: Stroke; computed tomography; hemorrhage; telemedicine; thrombolysis