Diagnostic accuracy in teleneurological stroke consultations

• Verfasst von: Kühne Escolà, Jordi [VerfasserIn]
• Verfasst von: Nagel, Simon [VerfasserIn]
• Verfasst von: Verez Sola, Christina [VerfasserIn]
• Verfasst von: Doroszewski, Eva [VerfasserIn]
• Verfasst von: Jaschonek, Hannah [VerfasserIn]
• Verfasst von: Gutschalk, Alexander [VerfasserIn]
• Verfasst von: Gumbinger, Christoph [VerfasserIn]
• Verfasst von: Purrucker, Jan [VerfasserIn]
• Titel: Diagnostic accuracy in teleneurological stroke consultations
• Verf.angabe: Jordi Kühne Escolà, Simon Nagel, Christina Verez Sola, Eva Doroszewski, Hannah Jaschonek, Alexander Gutschalk, Christoph Gumbinger, and Jan C. Purrucker
• E-Jahr: 2021
• Jahr: 11 March 2021
• Umfang: 10 S.
• Teil: volume:10
• Teil: year:2021
• Teil: number:6
• Teil: elocationid:1170
• Teil: pages:1-10
• Teil: extent:10
• Fussnoten: Gesehen am 11.06.2021
• Titel Quelle: Enthalten in: Journal of Clinical Medicine
• Ort Quelle: Basel : MDPI, 2012
• Jahr Quelle: 2021
• Band/Heft Quelle: 10(2021), 6, Artikel-ID 1170, Seite 1-10
• ISSN Quelle: 2077-0383
• DOI: doi:10.3390/jcm10061170
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1760296627

Abstract

Background: The accuracy of diagnosing acute cerebrovascular disease via a teleneurology service and the characteristics of misdiagnosed patients are insufficiently known. Methods: A random sample (n = 1500) of all teleneurological consultations conducted between July 2015 and December 2017 was screened. Teleneurological diagnosis and hospital discharge diagnosis were compared. Diagnoses were then grouped into two main categories: cerebrovascular disease (CVD) and noncerebrovascular disease. Test characteristics were calculated. Results: Out of 1078 consultations, 52% (n = 561) had a final diagnosis of CVD. Patients with CVD could be accurately identified via teleneurological consultation (sensitivity 95.2%, 95% CI 93.2-96.8), but we observed a tendency towards false-positive diagnosis (specificity 77.4%, 95% CI 73.6-80.8). Characteristics of patients with a false-negative CVD diagnosis were similar to those of patients with a true-positive diagnosis, but patients with a false-negative CVD diagnosis had ischemic heart disease less frequently. In retrospect, one patient would have been considered a candidate for intravenous thrombolysis (0.2%). Conclusions: Teleneurological consultations are accurate for identifying patients with CVD, and there is a very low rate of missed candidates for thrombolysis. Apart from a lower prevalence of ischemic heart disease, characteristics of “stroke chameleons” were similar to those of correctly identified CVD patients.