Zerna Charlotte, von Kummer Ruediger, Gerber Johannes, Engellandt Kai, Abramyuk Andrij, Wojciechowski Claudia, Barlinn Kristian, Kepplinger Jessica, Pallesen Lars-Peder, Siepmann Timo, Dzialowski Imanuel, Reichmann Heinz, Puetz Volker, Bodechtel Ulf
Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany.
Division of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany.
J Stroke Cerebrovasc Dis. 2015 Jul;24(7):1520-6. doi: 10.1016/j.jstrokecerebrovasdis.2015.03.022. Epub 2015 Apr 11.
The Stroke Eastern Saxony Network (SOS-NET) provides telecare for acute stroke patients. Stroke neurologists recommend intravenous thrombolysis based on clinical assessment and cerebral computed tomography (CT) evaluation using Alberta Stroke Program Early CT score (ASPECTS). We sought to assess whether ASPECTS misinterpretation by stroke neurologists was associated with thrombolysis-related symptomatic intracranial hemorrhage (sICH).
We retrospectively analyzed consecutive SOS-NET patients treated with thrombolytics from July 2007 to July 2012. Experienced neuroradiologists re-evaluated CT scans blinded to clinical information providing reference standard. We defined ASPECTS underestimation as ASPECTS stroke neurologist--ASPECTS neuroradiologist more than 1 point. Primary outcome was sICH by European Cooperative Acute Stroke Study II criteria. Secondary outcome was unfavorable outcome at discharge defined as modified Rankin Scale scores 3 or more.
Of 1659 patients with acute ischemic stroke, thrombolysis was performed in 657 patients. Complete primary outcome and imaging data were available for 432 patients (median age, 75; interquartile range [IQR], 12 years; National Institutes of Health Stroke Scale score, 12 [IQR, 11]; 52.8% women). Nineteen patients (4.4%) had sICH, and 259 patients (60.0%) had an unfavorable outcome at discharge. Interobserver agreement between ASPECTS assessment was fair (κ = .51). ASPECTS underestimation was neither associated with sICH (adjusted odds ratio (OR), 1.32; 95% confidence interval (CI), .36-4.83, P = .68) nor unfavorable outcome (adjusted OR, 1.10; 95% CI, .47-2.54; P = .83).
Despite fair interrater agreement between stroke neurologists and expert neuroradiologists, underestimation of ASPECTS by the former was not associated with thrombolysis-related sICH in our telestroke network.
萨克森东部卒中网络（SOS-NET）为急性卒中患者提供远程护理。卒中神经科医生根据临床评估和使用阿尔伯塔卒中项目早期CT评分（ASPECTS）的脑计算机断层扫描（CT）评估来推荐静脉溶栓治疗。我们旨在评估卒中神经科医生对ASPECTS的误判是否与溶栓相关的症状性颅内出血（sICH）有关。
我们回顾性分析了2007年7月至2012年7月期间接受溶栓治疗的连续SOS-NET患者。经验丰富的神经放射科医生在不知道临床信息的情况下重新评估CT扫描，以提供参考标准。我们将ASPECTS低估定义为卒中神经科医生的ASPECTS评分减去神经放射科医生的ASPECTS评分大于1分。主要结局是根据欧洲急性卒中协作研究II标准判定的sICH。次要结局是出院时的不良结局，定义为改良Rankin量表评分3分或更高。
在1659例急性缺血性卒中患者中，657例接受了溶栓治疗。432例患者（中位年龄75岁；四分位间距[IQR]为12岁；美国国立卫生研究院卒中量表评分12分[IQR，11分]；52.8%为女性）有完整的主要结局和影像学数据。19例患者（4.4%）发生sICH，259例患者（60.0%）出院时预后不良。ASPECTS评估之间的观察者间一致性一般（κ = 0.51）。ASPECTS低估既与sICH无关（校正比值比[OR]为1.32；9５%置信区间[CI]为0.36-4.83，P = 0.68），也与不良结局无关（校正OR为1.10；95%CI为0.47-2.54；P = 0.83）。
尽管卒中神经科医生与专家神经放射科医生之间的评分者间一致性一般，但在我们的远程卒中网络中，前者对ASPECTS的低估与溶栓相关的sICH无关。
