Clinical Judgment to Recognize Acute Brain Ischemia in the Emergency Department

IF 1.1 3区医学 Q2 CLINICAL NEUROLOGY

Acta Neurologica Scandinavica Pub Date : 2026-08-31 DOI:10.1155/ane/2254119

Max Bieder, Felix L. Nägele, Simon Kessner, Moritz A. Link, Thies Ingwersen, Märit Jensen, Lukas Meyer, Bastian Cheng, Götz Thomalla, Eckhard Schlemm

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引用次数: 0

Abstract

Background

Despite the development of scale-based stroke recognition tools, the accuracy of clinical judgment to detect acute ischemic stroke (AIS) and transient ischemic attack (TIA) is unknown. This study evaluated the real-world accuracy of stroke physicians′ assessment in AIS/TIA detection before imaging compared with Recognition of Stroke in the Emergency Room (ROSIER) scale and analyzed clinical features of patients with AIS/TIA compared with stroke mimics.

Methods

Patients with suspected acute stroke at a tertiary neurovascular center were rated for AIS/TIA likelihood before brain imaging (0%–100%). The diagnostic performance of clinical judgment and ROSIER scale was assessed using area under the receiver operating curve (AUC), sensitivity, specificity, positive (PPV) and negative predictive value (NPV). Associations with acute reperfusion treatments were examined using multivariable logistic regression.

Results

Among 540 patients, 50.6% (n = 273) had AIS/TIA, 43.1% (n = 233) SMs, and 6.3% (n = 34) intracerebral hemorrhage. Clinical judgment was performed for 242 patients, yielding an AUC of 0.85 (95% CI, [0.80–0.90]) with sensitivity, specificity, PPV, and NPV of 90.8%, 70.3%, 81.0%, and 84.5%, respectively. ROSIER scale had an AUC of 0.84 (95% CI [0.80–0.89]), sensitivity of 70.1%, specificity of 81.8%, PPV of 87.1%, and NPV of 61.0%. Logistic regression revealed a positive association between the clinical likelihood of brain ischemia, the ROSIER scale, and acute reperfusion therapies. The most frequent SMs were infections (24.9%; n = 58), seizures (18.5%; n = 43), and metabolic disturbances (9.0%; n = 21), with altered consciousness as the most common presenting symptom (45.1%; n = 105).

Conclusions

This study is the first to quantify the accuracy of preimaging clinical judgment for AIS/TIA detection in an emergency setting, showing comparable results with the ROSIER scale but with higher sensitivity. Future research should explore how clinical expertise can be integrated into standardized stroke pathways to optimize early management.

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急诊诊断急性脑缺血的临床判断

尽管基于量表的脑卒中识别工具有所发展，但临床判断检测急性缺血性脑卒中（AIS）和短暂性脑缺血发作（TIA）的准确性尚不清楚。本研究评估了卒中医生在成像前AIS/TIA检测评估与急诊室卒中识别（ROSIER）量表的真实世界准确性，并分析了AIS/TIA患者与卒中模拟患者的临床特征。方法对三级神经血管中心疑似急性脑卒中患者进行脑显像前AIS/TIA可能性评分（0% ~ 100%）。采用受试者工作曲线下面积（AUC）、敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）评价临床判断和ROSIER量表的诊断效能。采用多变量logistic回归检验与急性再灌注治疗的关系。结果540例患者中，AIS/TIA占50.6% (n = 273)， SMs占43.1% (n = 233)，脑出血占6.3% （n = 34）。242例患者进行临床判断，AUC为0.85 (95% CI,[0.80-0.90])，敏感性、特异性、PPV和NPV分别为90.8%、70.3%、81.0%和84.5%。ROSIER量表的AUC为0.84 (95% CI[0.80-0.89])，敏感性为70.1%，特异性为81.8%，PPV为87.1%，NPV为61.0%。Logistic回归显示脑缺血的临床可能性、ROSIER评分与急性再灌注治疗呈正相关。最常见的SMs是感染（24.9%,n = 58）、癫痫发作（18.5%,n = 43）和代谢紊乱（9.0%,n = 21），意识改变是最常见的表现症状（45.1%,n = 105）。本研究首次量化了紧急情况下AIS/TIA检测成像前临床判断的准确性，结果与ROSIER量表相当，但灵敏度更高。未来的研究应探索如何将临床专业知识整合到标准化的卒中途径中，以优化早期管理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Neurologica Scandinavica 医学-临床神经学

CiteScore

6.70

自引率

2.90%

发文量

161

审稿时长

4-8 weeks

期刊介绍： Acta Neurologica Scandinavica aims to publish manuscripts of a high scientific quality representing original clinical, diagnostic or experimental work in neuroscience. The journal''s scope is to act as an international forum for the dissemination of information advancing the science or practice of this subject area. Papers in English will be welcomed, especially those which bring new knowledge and observations from the application of therapies or techniques in the combating of a broad spectrum of neurological disease and neurodegenerative disorders. Relevant articles on the basic neurosciences will be published where they extend present understanding of such disorders. Priority will be given to review of topical subjects. Papers requiring rapid publication because of their significance and timeliness will be included as ''Clinical commentaries'' not exceeding two printed pages, as will ''Clinical commentaries'' of sufficient general interest. Debate within the speciality is encouraged in the form of ''Letters to the editor''. All submitted manuscripts falling within the overall scope of the journal will be assessed by suitably qualified referees.