Out-of-hospital diagnosis of cerebral infarction versus intracranial hemorrhage

Objective: To establish a model based on clinical and anamnestic data easil y available in the out-of-hospital setting, which facilitates the different ial diagnosis between cerebral infarction and intracranial hemorrhage. Desi gn: Retrospective study that simulates a prospective approach. Setting: Eme rgency Department of the University Hospital in Vienna, Austria. Patients a nd participants: Data of 224 patients with either intracranial hemorrhage o r cerebral infarction were prospectively collected. Uni- and multivariate a nalysis was performed to identify neurological symptoms and anamnestic data , which were associated with either intracranial hemorrhage or cerebral inf arction. Measurements and results: Unilateral weakness or sensory loss was observed more frequently in patients with infarction compared to hemorrhage (69.8 % vs 11.9 %, P < 0.001). The frequency of patients with impaired lev el of consciousness was significantly higher in the hemorrhage group compar ed to the infarction group (59.3 % vs 3.8 %, P < 0.001). A multivariate log istic regression analysis showed that hypertension (OR = 0.31, 95 % CI = 0. 12-0.76, P = 0.01), diabetes (OR = 0.17, 95 % CI = 0.04-0.68, P = 0.01), an d unilateral weakness or sensory loss (OR = 0.10, 95 % CI = 0.04-0.26, P < 0.001) were significantly associated with cerebral infarction. Impaired lev el of consciousness was significantly related to hemorrhage (OR = 13.41, 95 % CI = 3.92-45.91, P < 0.001). On the basis of the logistic regression ana lysis, we generated a scoring system for the out-of-hospital diagnosis betw een infarction and hemorrhage. The values of the score lay between -3 and 3. The probability of infarction increases when the score becomes negative, and the probability for hemorrhage increases when the score becomes positi ve. Conclusion: Our model is a useful guideline for the differential diagno sis between cerebral infarction and intracranial hemorrhage in the out-of-h ospital setting, as it is based on easily available clinical and anamnestic parameters.