emergency physician's diagnosis of stroke subtype: an accuracy study diagnóstico dos subtipos de acidente vascular cerebral: um estudo de acurácia com médicos de emergência

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ID: 158560
1998
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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 stroke admitted to the Emergency Ward of a Brazilian University Hospital were examined by emergency physicians and computerised tomography (CT). We also compared it (physician's unstructured diagnosis) to two published clinical scoring systems (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 by emergency physicians) and the available diagnostic tests fail to confidently discriminate CH and CI.
OBJETIVO: Avaliar a acurácia do diagnóstico clínico não estruturado e do estruturado dos subtipos do acidente vascular cerebral (AVC): hemorragia cerebral (HC), infarto cerebral (IC), hemorragia subaracnóide (HSA). MÉTODO: Sessenta pacientes com AVC consecutivamente admitidos em emergência de hospital universitário brasileiro foram examinados por médicos da emergência e por tomografia computadorizada (TC). Nós também comparamos isso (diagnóstico clínico não estruturado) com os resultados de dois testes diagnósticos estruturados sobre AVC da literatura (Guy's Hospital e Siriraj Hospital) aplicados a três outras populações -- com atenção às características operacionais dos testes. RESULTADOS: Em nossos dados pessoais, entre nove variáveis que poderiam discriminar HC e IC, três apresentaram diferenças significantes estatisticamente (p<0.05): cefaléia (p=0.0002) e vômito (p=0.02) ocorreram mais frequentemente naqueles com HC, mas AVC prévio naqueles com IC (p=0.04). Diagnóstico não estruturado mostrou-se válido para HSA, com +LHR= 39.7; e em menor grau para IC (-LHR= 0,1). No entanto, ele exibiu baixa sensibilidade para o diagnóstico de HC. Testes estruturados (Guy's Hospital and Siriraj Hospital) também falharam para o diagnóstico seguro dos subtipos de AVC, especialmente da HC. CONCLUSÃO: O diagnóstico clínico (feito por médicos de emergência) e os instrumentos diagnósticos estudados não diferenciam de modo confiável HC e IC.
Reference Key
gomes1998arquivosemergency Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors ;MARLEIDE DA MOTA GOMES;MONICA FONSECA COSTA;CHARLES ANDRÉ;RAQUEL GOMES;SÉRGIO A.P. NOVIS
Journal communications in computer and information science
Year 1998
DOI
10.1590/S0004-282X1998000400001
URL
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X1998000400001
Keywords
diagnosis cerebrovascular disease diagnóstico neuropsychiatry biological psychiatry medical educationneurosciences

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