EMERGENCY PHYSICIANS - ACCURACY IN THE DIAGNOSIS OF STROKE

Background and Purpose The role of emergency physicians in trials of a cute stroke therapy is expanding. We investigated the ability of emerg ency physicians to accurately identify patients with stroke. Methods W e reviewed all 446 patients who were evaluated in the emergency depart ment and had an inpatient admitting or discharge diagnosis of ischemic or hemorrhagic stroke from May 1, 1992, to June 30, 1993. The final a dmitting diagnosis made by the emergency physician was compared with t he final hospital discharge diagnosis, 95% of which were made by neuro logists or neurosurgeons. Results All 76 patients with a final dischar ge diagnosis of intracerebral or subarachnoid hemorrhage were correctl y diagnosed by the emergency physicians (sensitivity: 100%; positive p redictive value, 100%). Of the 351 patients with a final discharge dia gnosis of ischemic stroke or transient ischemic attack, 346 were corre ctly identified by the emergency physicians (sensitivity, 98.6%; posit ive predictive value, 94.8%). Nineteen patients were diagnosed with st roke or transient ischemic attack by the emergency physician but had a final discharge diagnosis other than stroke. Discharge diagnoses incl uded paresthesia or numbness of unknown causes (3), seizure (2), compl icated migraine (2), peripheral neuropathy (2), cranial nerve neuropat hy (2), psychogenic paralysis (1), and other (7). Conclusions Emergenc y physicians at a large urban teaching hospital with a comprehensive s troke intervention program can accurately identify patients with strok e, particularly hemorrhagic stroke. If similar accuracy can be documen ted in other types of hospitals, emergency physicians may become key p roviders of urgent stroke intervention.