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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Neurol. | doi: 10.3389/fneur.2019.00997

Interdisciplinary decision making in hemorrhagic stroke based on CT imaging – Differences between neurologists and neurosurgeons regarding estimation of patients’ symptoms, GCS and NIHSS

 Andrea Wagner1*, Karl-Michael Schebesch2,  Stefan Isenmann3,  Andreas Steinbrecher4, Thomas Kapapa5, Florian Zeman2,  Dobri Baldaranov1, Oliver Grauer6, Roland Backhaus7, Ralf A. Linker1 and  Felix Schlachetzki1
  • 1University of Regensburg, Germany
  • 2University Medical Center Regensburg, Germany
  • 3St. Josef Hospital GmbH, Germany
  • 4Helios Hospital Erfurt, Germany
  • 5Ulm University Medical Center, Germany
  • 6Independent researcher, Germany
  • 7Clinic Hirslanden Zurich, Switzerland

Background and purpose: Acute intracerebral hemorrhage (ICH) requires rapid decision making towards 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 NIHSS as well as 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. ΔNIHSS-points (ΔGCS-points) were calculated as the difference between actual and rated NIHSS (GCS) including 95% confidence interval (CI).
Results: Mean ΔGCS-points for neurosurgeons was 1.16 (95%-CI: -2.67 to 4.98); for neurologists 0.99 (95%-CI: -2.58 to 4.55), p=0.308; mean ΔNIHSS-points for neurosurgeons was -2.95 (95% CI: -12.71 to 6.82); for neurologists -0.33 (95% CI -9.60 to 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.

Keywords: intracerebral hemorrhage (ICH), Glasgow Coma Scale (GCS), NIHSS, Computed tomography (CT), cerebral amyloid angiopathy (CAA), Quality of Life, Outcome, Telestroke

Received: 09 May 2019; Accepted: 02 Sep 2019.

Copyright: © 2019 Wagner, Schebesch, Isenmann, Steinbrecher, Kapapa, Zeman, Baldaranov, Grauer, Backhaus, Linker and Schlachetzki. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Andrea Wagner, University of Regensburg, Regensburg, Bavaria, Germany, andrea.wagner@klinik.uni-regensburg.de