Year: 2006
Type: editorial
Abstract: C linicians recognize that the history and physical examination form the basis of diagnosis and are critical for determining a treatment plan for patients with suspected stroke.This central role of the history and examination are reflected in the ASA/AHA Stroke Council's Guidelines for the Early Management of Patients With Ischemic Stroke. 1 Quality literature on this important topic is surprisingly limited.After eliminating review articles and case series, a MEDLINE search conducted as part of a systematic review of English language articles (1994 -2005) yielded only 4 potentially relevant studies. 2 Two related reports now add to our knowledge of this important subject.3,4 Prior work shows that symptoms associated with high interobserver agreement for the diagnosis of stroke or TIA versus no vascular event are a sudden change in speech, visual loss, diplopia, numbness or tingling, paralysis or weakness and nonorthostatic dizziness (ϭ0.60, 95% CI: 0.52 to 0.68). 2 The reliabilities of individual neurological findings varies from slight to almost perfect but can be improved with the use of standardized scoring systems. 2 The first of the 2 new reports focuses on interobserver agreement (ie, reliability) for the bedside clinical assessment of patients with suspected stroke.3 There are 2 important caveats to bear in mind when considering the results.Historic information was obtained only from the patients themselves, many of whom were confused.In the usual clinical setting, historic information is gleaned from the patient, family members, as well as other observers including emergency medical personnel.It is the combination of information from these sources that is used to aid diagnosis and clinical decisions.Second, only 15 patients (15%) were assessed within 12 hours of onset.It is conceivable that the reliability of historic information, including time of onset data, might be either more or less reliable than reported in this study when obtained from several sources in a hyperacute population.Consistent with previous studies, Hand et al also found that interobserver reliability for most items of the history can be assessed with moderate-to-good reliability (eg, point estimates of the statistic for vascular risk factors ranged from 0.44 to 0.69).3 Interobserver agreement for various features of the neurolog-The opinions in this editorial are not necessarily those of the editors or of the American Heart Association.
Source: Stroke
Author: Larry B. Goldstein
Institutions: Duke University, Duke Medical Center, Durham VA Medical Center
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2165241265