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Diagnostic accuracy in teleneurological stroke consultations

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 scre...

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Main Authors: Kühne Escolà, Jordi (Author) , Nagel, Simon (Author) , Verez Sola, Christina (Author) , Doroszewski, Eva (Author) , Jaschonek, Hannah (Author) , Gutschalk, Alexander (Author) , Gumbinger, Christoph (Author) , Purrucker, Jan (Author)
Format: Article (Journal)
Language:English
Published: 11 March 2021
In: Journal of Clinical Medicine
Year: 2021, Volume: 10, Issue: 6, Pages: 1-10
ISSN:2077-0383
DOI:10.3390/jcm10061170
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.3390/jcm10061170
Verlag, lizenzpflichtig, Volltext: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7998723/
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Author Notes:Jordi Kühne Escolà, Simon Nagel, Christina Verez Sola, Eva Doroszewski, Hannah Jaschonek, Alexander Gutschalk, Christoph Gumbinger, and Jan C. Purrucker
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Summary: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.
Item Description:Gesehen am 11.06.2021
Physical Description:Online Resource
ISSN:2077-0383
DOI:10.3390/jcm10061170

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