Emergency physician's diagnosis of stroke subtype: an accuracy study

ABSTRACT

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 atroke admitted to the Emergency Ward of a Brazilian University Hospital were examined by emergency physicians and computerised tomography (CT). We also compared it (physycian's unstructured diagnosis) to two published clinical scoring (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 be emergency physicians) and the available diagnostic tests fail to confidently discriminate CH and CI.