Cranial Computed Tomography Interpretation in Acute Stroke

Abstract

Context.—Intracranial hemorrhage must be excluded prior to administration of thrombolytic agents in acute stroke. Objective.—To evaluate physician accuracy in cranial computed tomography scan interpretation for determining eligibility for thrombolytic therapy in acute stroke. Design.—Administration of randomly selected, randomly ordered series of 15 computed tomography scans from a pool of 54 scans that demonstrated intrace- rebral hemorrhage, acute infarction, intracerebral calcifications (impostor for hem- orrhage), old cerebral infarction (impostor for acute infarction), and normal findings. Participants.—A convenience sample of 38 emergency physicians, 29 neu- rologists, and 36 general radiologists. Main Outcome Measures.—Physician determination of eligibility for thrombo- lytic therapy based on computed tomography scan interpretation. Results.—Average correct score by all physicians on all computed tomography scans was 77% (95% confidence interval, 74%-80%). Of 569 computed tomogra- phy readings by emergency physicians, 67% were correct; of 435 readings by neurologists, 83% were correct; and of 540 readings by radiologists, 83% were correct. Overall sensitivity for detecting hemorrhage was 82% (95% confidence in- terval, 78%-85%); 17% of emergency physicians, 40% of neurologists, and 52% of radiologists achieved 100% sensitivity for identification of hemorrhage. Conclusion.—Physicians in this study did not uniformly achieve a level of sen- sitivity for identification of intracerebral hemorrhage sufficient to permit safe selec- tion of candidates for thrombolytic therapy.