Martin P J, Young G, Enevoldson T P, Humphrey P R
Department of Neurology, Walton Centre for Neurology and Neurosurgery, Liverpool, UK.
QJM. 1997 Dec;90(12):759-63. doi: 10.1093/qjmed/90.12.759.
We compared the referral diagnoses of TIAs and minor strokes made by non-specialists with those of two consultant neurologists, in 565 consecutive cerebrovascular clinic patients, of whom 508 (90%) were referred with a diagnosis of any TIA or stroke. In 373 (73%), the neurologists felt the diagnosis of a cerebrovascular event to be correct. Agreement with the vascular syndrome (CVA vs. TIA) was significantly higher for patients with a referral diagnosis of stroke (136/176) (77%) than it was for patients with a referral diagnosis of TIA (200/332) (60%) (difference in proportions 17%, 95% CI 9-25). In 37 patients (7%) the neurologists confirmed the diagnosis of cerebrovascular disease but not the specific TIA/stroke diagnosis. Vascular surgeons were more likely to be correct in their referral diagnosis of carotid territory cerebrovascular disease (88% correct) than all other sources combined (63% correct) (difference in proportions 25%, 95% CI 11-39), but there was no significant variation in diagnostic accuracy between other individual groups. In 135/508 patients (27%) referred as any TIA or stroke, the diagnosis of cerebrovascular disease was undone. Alternative diagnoses included migraine (3%), epilepsy (1%), hyperventilation (1%), multiple sclerosis (1%) and a case of idiopathic Parkinson's disease, but many symptoms (8%) were unclassifiable. A strict comparison of diagnostic accuracy would have required assessment of patients not referred for specialist opinion, to estimate false-negative as well as false-positive diagnoses. However, in this patient group (which reflects current local practice) TIAs and strokes seem overdiagnosed.
我们将565例连续就诊于脑血管门诊的患者中，非专科医生对短暂性脑缺血发作（TIA）和轻度卒中的转诊诊断，与两位神经科顾问医生的诊断进行了比较。其中508例（90%）患者转诊时被诊断为TIA或卒中。在373例（73%）患者中，神经科医生认为脑血管事件的诊断是正确的。对于转诊诊断为卒中的患者（136/176）（77%），与血管综合征（脑血管意外[CVA]与TIA）的一致性显著高于转诊诊断为TIA的患者（200/332）（60%）（比例差异17%，95%可信区间9 - 25）。在37例（7%）患者中，神经科医生确认了脑血管疾病的诊断，但未确认具体的TIA/卒中诊断。血管外科医生对颈动脉区域脑血管疾病的转诊诊断更有可能正确（88%正确），高于所有其他来源的综合诊断（63%正确）（比例差异25%，95%可信区间11 - 39），但其他个体组之间的诊断准确性没有显著差异。在508例转诊诊断为TIA或卒中的患者中，有135例（27%）被排除了脑血管疾病的诊断。其他诊断包括偏头痛（3%）、癫痫（1%）、换气过度（1%）、多发性硬化（1%）以及1例特发性帕金森病，但许多症状（8%）无法分类。要进行严格的诊断准确性比较，需要评估未转诊至专科医生处的患者，以估计假阴性和假阳性诊断。然而，在这个患者群体（反映了当前当地的医疗实践）中，TIA和卒中似乎被过度诊断了。
