Abstract
Objectives: Access to acute stroke interventions in the emergency department (ED) relies on correct clinical diagnosis. Our aims were to determine the accuracy and reliability of pediatric ED physician diagnosis of childhood stroke and other conditions presenting with brain attack symptoms. Methods: Prospective study of consecutive children aged one month-18 years presenting to the ED from June 2009-December 2010 with focal neurological deficits. Accuracy (sensitivity, specificity, receiver operator characteristic curves (ROCs)), and inter-rater agreement (kappa (κ )) were determined, between ED physician diagnoses, as recorded in the electronic hospital administrative software system, and final neurological diagnosis, following completion of diagnostic work-up. Results: Two-hundred-eighty seven children with 301 consecutive presentations were recruited. The most common final brain attack diagnoses included migraine in 84 children, first seizure in 48, Bell’s palsy in 29, stroke in 21, and conversion disorders in 18 children. Sensitivity of ED physician stroke diagnosis was 62% and specificity was 98% (ROC 0.8). Inter-rater agreement for ED physician and final stroke diagnosis was substantial (κ 0.61). ED physician diagnostic accuracy and reliability was highest for Bell’s palsy (ROC 0.98, κ 0.96), and lowest for CNS demyelination (ROC 0.5, κ -0.01) and cerebellitis (ROC 0.50, κ 0.50). Conclusions: ED physician diagnostic accuracy and reliability varies considerably across disorders presenting with brain attack symptoms. Clinical recognition tools are required to assist pediatric ED physicians with diagnosis of stroke and other serious neurological disorders.
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.