title: Assessment of acute stroke cerebral CT examinations by anaesthesiologists.
abstract: OBJECTIVE
  It is essential to diagnose ischaemic stroke as soon as possible after symptom onset, so that thrombolytic treatment can be initiated as quickly as possible. This might be greatly facilitated if cerebral CT could be carried out in a pre-hospital setting. The aim of this study was to evaluate if anaesthesiologists, who in Norway provide pre-hospital medical care, could be trained to assess cerebral CT scans to exclude radiological contraindications for thrombolytic stroke treatment.
  
  
  METHODS
  Thirteen anaesthesiologists attended an 8-h course in acute stroke assessment, including a 2-h introduction to the neuroradiology of acute stroke. Each participant then assessed 12 non-contrast cerebral CT examinations of acute stroke patients with specific regard to radiological contraindications for thrombolytic therapy. Test results were compared with those of three experienced neuroradiologists. Inter-rater agreement between anaesthesiologists and neuroradiologists was calculated using Cohen's Kappa statistics. Robustness of the results was assessed using the non-parametric bootstrap.
  
  
  RESULTS
  Among the neuroradiologists, Kappa was 1 for detecting radiological contraindications for thrombolytic therapy. Twelve of the 13 anaesthesiologists showed good or excellent agreement (Kappa > 0.60) with the neuroradiologists. The anaesthesiologists spent a median time of 2 min and 18 s on each CT scan.
  
  
  CONCLUSIONS
  This study suggests that anaesthesiologists who are experienced in pre-hospital care may be quickly trained to assess cerebral CT examinations in acute stroke patients with regard to radiological contraindications for thrombolytic therapy.
authors.affiliation: Department of Research and Development, The Norwegian Air Ambulance Foundation, Drøbak, Norway.
authors.forename: M R
authors.initials: MR
authors.lastname: Hov
authors.affiliation: Department of Neuroradiology, Oslo Norway, Oslo University Hospital, Oslo, Norway.
authors.forename: T
authors.initials: T
authors.lastname: Nome
authors.affiliation: Department of Research and Development, The Norwegian Air Ambulance Foundation, Drøbak, Norway.
authors.forename: E
authors.initials: E
authors.lastname: Zakariassen
authors.affiliation: Department of Neurology, Oslo University Hospital, Oslo, Norway.
authors.forename: D
authors.initials: D
authors.lastname: Russell
authors.affiliation: Department of Health Sciences, University of Stavanger, Oslo, Norway.|Department of Biostatistics, University of Oslo, Oslo, Norway.
authors.forename: J
authors.initials: J
authors.lastname: Røislien
authors.affiliation: Department of Research and Development, The Norwegian Air Ambulance Foundation, Drøbak, Norway.|Department of Biostatistics, University of Oslo, Oslo, Norway.
authors.forename: H M
authors.initials: HM
authors.lastname: Lossius
authors.affiliation: Department of Research and Development, The Norwegian Air Ambulance Foundation, Drøbak, Norway.|Department of Neurology, Oslo University Hospital, Oslo, Norway.
authors.forename: C G
authors.initials: CG
authors.lastname: Lund
mesh_terms: D000208:Acute Disease; D001921:Brain / Q000000981:diagnostic imaging*; D006801:Humans; D009664:Norway; D015588:Observer Variation; D015203:Reproducibility of Results; D020521:Stroke / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed