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 (<i>n</i> = 1500) of all teleneurological consultations conducted between July 2015 and Dec...
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| Format: | Article |
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MDPI AG
2021-03-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/10/6/1170 |
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| author | Jordi Kühne Escolà Simon Nagel Christina Verez Sola Eva Doroszewski Hannah Jaschonek Alexander Gutschalk Christoph Gumbinger Jan C. Purrucker |
| author_facet | Jordi Kühne Escolà Simon Nagel Christina Verez Sola Eva Doroszewski Hannah Jaschonek Alexander Gutschalk Christoph Gumbinger Jan C. Purrucker |
| author_sort | Jordi Kühne Escolà |
| collection | DOAJ |
| description | 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 (<i>n</i> = 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% (<i>n</i> = 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. |
| first_indexed | 2024-03-10T13:21:40Z |
| format | Article |
| id | doaj.art-cc5063dcd6354291b8723cf9e8c4e09a |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T13:21:40Z |
| publishDate | 2021-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-cc5063dcd6354291b8723cf9e8c4e09a2023-11-21T10:01:57ZengMDPI AGJournal of Clinical Medicine2077-03832021-03-01106117010.3390/jcm10061170Diagnostic Accuracy in Teleneurological Stroke ConsultationsJordi Kühne Escolà0Simon Nagel1Christina Verez Sola2Eva Doroszewski3Hannah Jaschonek4Alexander Gutschalk5Christoph Gumbinger6Jan C. Purrucker7Department of Neurology, Heidelberg University Hospital, 69120 Heidelberg, GermanyDepartment of Neurology, Heidelberg University Hospital, 69120 Heidelberg, GermanyDepartment of Neurology, Heidelberg University Hospital, 69120 Heidelberg, GermanyDepartment of Neurology, Heidelberg University Hospital, 69120 Heidelberg, GermanyDepartment of Neurology, Heidelberg University Hospital, 69120 Heidelberg, GermanyDepartment of Neurology, Heidelberg University Hospital, 69120 Heidelberg, GermanyDepartment of Neurology, Heidelberg University Hospital, 69120 Heidelberg, GermanyDepartment of Neurology, Heidelberg University Hospital, 69120 Heidelberg, GermanyBackground: The accuracy of diagnosing acute cerebrovascular disease via a teleneurology service and the characteristics of misdiagnosed patients are insufficiently known. Methods: A random sample (<i>n</i> = 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% (<i>n</i> = 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.https://www.mdpi.com/2077-0383/10/6/1170cerebral strokecerebrovascular diseasediagnosticstelemedicineteleneurology |
| spellingShingle | Jordi Kühne Escolà Simon Nagel Christina Verez Sola Eva Doroszewski Hannah Jaschonek Alexander Gutschalk Christoph Gumbinger Jan C. Purrucker Diagnostic Accuracy in Teleneurological Stroke Consultations Journal of Clinical Medicine cerebral stroke cerebrovascular disease diagnostics telemedicine teleneurology |
| title | Diagnostic Accuracy in Teleneurological Stroke Consultations |
| title_full | Diagnostic Accuracy in Teleneurological Stroke Consultations |
| title_fullStr | Diagnostic Accuracy in Teleneurological Stroke Consultations |
| title_full_unstemmed | Diagnostic Accuracy in Teleneurological Stroke Consultations |
| title_short | Diagnostic Accuracy in Teleneurological Stroke Consultations |
| title_sort | diagnostic accuracy in teleneurological stroke consultations |
| topic | cerebral stroke cerebrovascular disease diagnostics telemedicine teleneurology |
| url | https://www.mdpi.com/2077-0383/10/6/1170 |
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