Wagner, Andrea and Schebesch, Karl-Michael and Isenmann, Stefan and Steinbrecher, Andreas and Kapapa, Thomas and Zeman, Florian and Baldaranov, Dobri and Grauer, Oliver and Backhaus, Roland and Linker, Ralf A. and Schlachetzki, Felix (2019) Interdisciplinary Decision Making in Hemorrhagic Stroke Based on CT Imaging - Differences Between Neurologists and Neurosurgeons Regarding Estimation of Patients' Symptoms, Glasgow Coma Scale, and National Institutes of Health Stroke Scale. FRONTIERS IN NEUROLOGY, 10: 997. ISSN 1664-2295,
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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. Delta NIHSS points (Delta GCS points) were calculated as the difference between actual and rated NIHSS (GCS) including 95% confidence interval (CI). Results: Mean Delta GCS 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 Delta NIHSS 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.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | INTRACEREBRAL HEMORRHAGE; CARE PROFESSIONALS; GRADING SCALE; MANAGEMENT; GUIDELINES; RECOVERY; HEMATOMA; SURGERY; MODEL; intracerebral hemorrhage; Glasgow coma scale; national institutes of health stroke scale; computed tomography; cerebral amyloid angiopathy; quality of life; outcome; telestroke |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Neurochirurgie Medicine > Lehrstuhl für Neurologie Medicine > Zentren des Universitätsklinikums Regensburg > Zentrum für Klinische Studien |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 27 Mar 2020 09:49 |
| Last Modified: | 27 Mar 2020 09:49 |
| URI: | https://pred.uni-regensburg.de/id/eprint/26221 |
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