Inter-rater Agreement for the Diagnosis of Stroke Versus Stroke Mimic

Ava Leigh Liberman, Sara K. Rostanski, Ilana M. Ruff, Ashley N.D. Meyer, Matthew B. Maas, Shyam Prabhakaran

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background and Purpose: Patients who present emergently with acute neurological signs and symptoms represent unique diagnostic challenges for clinicians. We sought to characterize the reliability of physician diagnosis in differentiating aborted or imaging-negative acute ischemic stroke from stroke mimic. Methods: We constructed 10 case-vignettes of patients treated with thrombolysis with subsequent clinical improvement who lacked radiographic evidence of infarction. Using an online survey, we asked physicians to select a most likely final diagnosis after reading each case-vignette. Inter-rater agreement was evaluated using percent agreement and κ statistic for multiple raters with 95% confidence intervals reported. Results: Sixty-five physicians participated in the survey. Most participants were in practice for ≥5 years and over half were vascular neurologists. Physicians agreed on the most likely final diagnosis 71% of the time, κ of 0.21 (95% confidence interval, 0.06-0.54). Percent agreement was similar across participant practice locations, years of experience, subspecialty training, and personal experience with thrombolysis. Conclusions: We found modest agreement among surveyed physicians in distinguishing ischemic stroke syndromes from stroke mimics in patients without radiographic evidence of infarction and clinical improvement after thrombolysis. Methods to improve diagnostic consensus after thrombolysis are needed to assure acute ischemic stroke patients and stroke mimics are treated safely and accurately.

Original languageEnglish (US)
Pages (from-to)118-121
Number of pages4
JournalNeurologist
Volume23
Issue number4
DOIs
StatePublished - Jul 1 2018

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Stroke
Physicians
Infarction
Confidence Intervals
Signs and Symptoms
Blood Vessels
tebufenozide
Reading
Surveys and Questionnaires

Keywords

  • diagnosis
  • inter-rater agreement
  • ischemic stroke
  • stroke mimic
  • thrombolysis

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Liberman, A. L., Rostanski, S. K., Ruff, I. M., Meyer, A. N. D., Maas, M. B., & Prabhakaran, S. (2018). Inter-rater Agreement for the Diagnosis of Stroke Versus Stroke Mimic. Neurologist, 23(4), 118-121. https://doi.org/10.1097/NRL.0000000000000187

Inter-rater Agreement for the Diagnosis of Stroke Versus Stroke Mimic. / Liberman, Ava Leigh; Rostanski, Sara K.; Ruff, Ilana M.; Meyer, Ashley N.D.; Maas, Matthew B.; Prabhakaran, Shyam.

In: Neurologist, Vol. 23, No. 4, 01.07.2018, p. 118-121.

Research output: Contribution to journalArticle

Liberman, AL, Rostanski, SK, Ruff, IM, Meyer, AND, Maas, MB & Prabhakaran, S 2018, 'Inter-rater Agreement for the Diagnosis of Stroke Versus Stroke Mimic', Neurologist, vol. 23, no. 4, pp. 118-121. https://doi.org/10.1097/NRL.0000000000000187
Liberman AL, Rostanski SK, Ruff IM, Meyer AND, Maas MB, Prabhakaran S. Inter-rater Agreement for the Diagnosis of Stroke Versus Stroke Mimic. Neurologist. 2018 Jul 1;23(4):118-121. https://doi.org/10.1097/NRL.0000000000000187
Liberman, Ava Leigh ; Rostanski, Sara K. ; Ruff, Ilana M. ; Meyer, Ashley N.D. ; Maas, Matthew B. ; Prabhakaran, Shyam. / Inter-rater Agreement for the Diagnosis of Stroke Versus Stroke Mimic. In: Neurologist. 2018 ; Vol. 23, No. 4. pp. 118-121.
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