Accuracy of CT-diagnostics by stroke neurologists in telemedicine for acute stroke patients

Abstract

Background: Telemedicine in acute stroke treatment is an option for stroke patients and is increasingly applied. The Stroke East Saxonia Network (SOS-NET) provides teleconsultations for 12 local hospitals in eastern Saxony, Germany. Stroke neurologists with special training in CT reading perform these teleconsultations. We studied the accuracy of the stroke neurologists' CT diagnosis and its impact on treatment decisions. Methods: For this study two experienced neuroradiologists (RVK, JG) evaluated randomly selected 110 CT scans out of 550 teleconsultations in 2009, blinded to clinical findings. All discrepant results were subsequently discussed and evaluated of all involved neurologists and neuroradiologists regarding the diagnostic accuracy and the impact on the therapeutic decisions. Results: The neuroradiologists agreed in all diagnoses of intracranial hemorrhages (N=20) and brain tumors (N=6). The experts disagreed in 20 of 84 scans of patients with ischemic stroke. In 11 of them, however, there was a difference in the ASPECT score by one point only, which we regarded as clinically irrelevant. Out of the nine remaining discrepancies, the neuroradiological judgment was corrected with the knowledge of the clinical information. In three other cases the stroke neurologists described moderate infarctions (ASPECTS 6-7) that were not confirmed by the experts. Thrombolytic therapy was recommended in all these patients and no bleeding complication occurred. In three cases, the stroke neurologists missed a large infarction of the MCA territory and recommended thrombolytic therapy that resulted in bleeding complication in one patient. In summary, the stroke neurologists missed three clinically relevant findings in 110 acute stroke patients (2.7%, 95% CI, 0.9% to 7.7%). Conclusion: Stroke neurologists can read CT in acute telestroke patients with high accuracy after special training. Misinterpretations of CT may have an impact on treatment and clinical outcome. Continuous training and quality control is mandatory.