Abstract
Background and Purpose: Acute intracerebral hemorrhage (ICH) requires rapid decision making toward neurosurgery or conservative neurological stroke unit treatment. In a previous study, we found overestimation of clinical symptoms when clinicians rely mainly on cerebral computed tomography (cCT) analysis. The current study investigates differences between neurologists and neurosurgeons estimating specific scores and clinical symptoms.Methods: Overall, 14 neurologists and 15 neurosurgeons provided clinical estimates and National Institutes of Health Stroke Scale (NIHSS) as well as Glasgow Coma Scale (GCS) based on cCT images and basic information of 50 patients with hypertensive and lobar ICH. Subgroup analyses were performed for the different professions (neurologists vs. neurosurgeons) and bleeding subtypes (typical location vs. atypical). The differences between the actual GCS and NIHSS scores and the cCT-imaging-based estimated scores were depicted as Bland–Altman plots and negative and positive predictive value (NPV and PPV) for prediction of clinical relevant items. ΔNIHSS points (ΔGCS points) were calculated as the difference between actual and rated NIHSS (GCS) including 95% confidence interval (CI).Results: Mean ΔGCS points for neurosurgeons was 1.16 (95% CI: −2.67–4.98); for neurologists, 0.99 (95% CI: −2.58–4.55), p = 0.308; mean ΔNIHSS points for neurosurgeons was −2.95 (95% CI: −12.71–6.82); for neurologists, −0.33 (95% CI: −9.60–8.94), p < 0.001. NPV and PPV for stroke symptoms were low, with large differences between different symptoms, bleeding subtypes, and professions. Both professions had more problems in proper rating of specific clinic–neurological symptoms than rating scores.Conclusion: Our results stress the need for joint decision making based on detailed neurological examination and neuroimaging findings also in telemedicine.
Highlights
Spontaneous intracerebral hemorrhages (ICHs) account for 10– 15% of all strokes in Western populations, with a case fatality of 40−55% [1]
Cerebral computed tomography images are primarily transferred to the specialist via telemedicine and ICH is identified as the cerebral pathology
In a previous study we demonstrated that rating National Institutes of Health Stroke Scale (NIHSS) and Glasgow Coma Scale (GCS) score merely according to the patients’ Cerebral computed tomography (cCT) leads to underestimation of GCS and overestimation of NIHSS score, indicating that the patients’ clinical symptoms were overestimated
Summary
Spontaneous intracerebral hemorrhages (ICHs) account for 10– 15% of all strokes in Western populations, with a case fatality of 40−55% [1]. Cerebral computed tomography (cCT) images are primarily transferred to the specialist via telemedicine and ICH is identified as the cerebral pathology. Significant predictive outcome factors for ICH include the volume of blood on the initial cCT scan, presence, and ongoing expansion of intraventricular hemorrhage (IVH), hematoma location, and expansion and the neurological status [2]. Further relevant predictors for outcome and functional independence after 100 days are the patient’s age and the National Institutes of Health Stroke Scale (NIHSS) score at initial presentation, regardless of the location of the ICH [3, 4]. Acute intracerebral hemorrhage (ICH) requires rapid decision making toward neurosurgery or conservative neurological stroke unit treatment. We found overestimation of clinical symptoms when clinicians rely mainly on cerebral computed tomography (cCT) analysis. The current study investigates differences between neurologists and neurosurgeons estimating specific scores and clinical symptoms
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