Journal of stroke medicine最新文献_第10页

DWI-FLAIR Mismatch-guided IVT is Safe and Effective in Treatment of AIS Beyond 4.5 Hours DWI-FLAIR错配引导下IVT治疗AIS超过4.5小时安全有效

Journal of stroke medicine Pub Date : 2020-11-11 DOI: 10.1177/2516608520953721

P. Ojha, S. Nagendra, S. Pujari, Rakeshsingh K. Singh, R. Lalla, V. Pathak, Aniruddha Joshi

{"title":"DWI-FLAIR Mismatch-guided IVT is Safe and Effective in Treatment of AIS Beyond 4.5 Hours","authors":"P. Ojha, S. Nagendra, S. Pujari, Rakeshsingh K. Singh, R. Lalla, V. Pathak, Aniruddha Joshi","doi":"10.1177/2516608520953721","DOIUrl":"https://doi.org/10.1177/2516608520953721","url":null,"abstract":"Background: Perfusion or clinical mismatch imaging is useful in selecting patients with acute ischemic stroke (AIS) for reperfusion therapies beyond 4.5 hours. These techniques are expensive, technically difficult, and therefore unavailable in most settings. The diffusion weighted imaging-fluid attenuated inversion recovery (DWI-FLAIR) mismatch pattern has been studied only in wake-up stroke/stroke with unclear time of onset but not in AIS patients with clear time of onset of more than 4.5 hours. This study assesses routinely available magnetic resonance imaging (MRI) DWI-FLAIR sequences for selecting AIS patients for intravenous thrombolytic therapy (IVT) beyond 4.5 hours of the witnessed onset of symptoms. Aim: To study the clinical spectrum and outcome of patients with AIS who received IVT based on the DWI-FLAIR mismatch seen beyond 4.5 hours of symptom onset. Methods, Observation, and Results: Retrospective analysis was performed on 10 patients who received IVT for AIS beyond 4.5 hours and had an MRI DWI-FLAIR mismatch. In cohort study, 60% patients were males, with the median age of 59 years, the median baseline National Institutes of Health Stroke Scale (NIHSS) score of 10 (range 7 to 15), and the median time from the onset to imaging of 412.5 minutes. Within 24 hours of thrombolysis, improvement of >4 points in NIHSS was seen in 7 out of 10 (70%) patients, and at the modified Rankin scale, the score of 0 to 1 was noted at 3 months in 8 out of 10 (80%) patients. Neuroimaging at 24 hours showed no intracerebral bleed. Discussion and Conclusion: DWI-FLAIR mismatch-guided IVT is safe and effective in patients with AIS beyond 4.5 hours of the onset of symptoms. More studies are recommended to confirm these findings.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83135837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Reliability of Clinical DWI Mismatch Approach to Predict Patient With the Probability of Large Infarct Growth: A Comparison of the Percentage of Infarct Growth and Clinical DWI Mismatch Status of the Patients With Acute Ischemic Stroke 临床DWI失配法预测大面积梗死增长概率的可靠性:急性缺血性卒中患者梗死增长百分比与临床DWI失配状态的比较

Journal of stroke medicine Pub Date : 2020-10-28 DOI: 10.1177/2516608520959541

Nganji Christian, H. Ghanaati, V. Changizi, B. Siroos, Farnoosh Mousavi

{"title":"Reliability of Clinical DWI Mismatch Approach to Predict Patient With the Probability of Large Infarct Growth: A Comparison of the Percentage of Infarct Growth and Clinical DWI Mismatch Status of the Patients With Acute Ischemic Stroke","authors":"Nganji Christian, H. Ghanaati, V. Changizi, B. Siroos, Farnoosh Mousavi","doi":"10.1177/2516608520959541","DOIUrl":"https://doi.org/10.1177/2516608520959541","url":null,"abstract":"Purpose: The purpose of this study is to highlight the reliability of clinical DWI mismatch (CDM) in the identification of patients with large infarct growth. Methods: We prospectively reviewed 21 ischemic stroke patients who underwent DWI imaging within 72 hours from stroke symptoms onset. Description of images was made by experienced radiologists. Lesion volumes were assessed by manually outlining the DWI infarct lesions area. The percentage of infarct growth was calculated by dividing the difference between second and first infarct volume by the first infarct volume times 100. The NIHSS scores were assessed by an experienced neurologist. CDM was defined as NIHSS score ≥8 and initial infarct volume on DWI ≤ 25 mL. Statistical Tests: We assessed the relationships of variables within different groups of CDM using nonparametric tests—Kruskal-Wallis and chi-square test. Sensitivity and specificity of CDM to predict large infarct growth were tested by using crosstabs table. Results: CDM was present in 36.8% of our patients and was associated with the percentage of infarct growth (P < .01). The mean percentage growth was high in patients with CDM (211.8%) while it was low in the group of patients without CDM (5.7%; group B and 10.7%; group C). The sensitivity and specificity of CDM to predict infarct growth was 77.8% vs 100% with a likelihood ratio of 15.4 (P = .0004). Conclusion: The approach of comparing CDM and percentage of infarct growth proved that the concept of CDM can accurately indicate the existence of a large volume of tissue at risk of infarction—penumbra.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72852501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Relationship Between N-Terminal Probrain Natriuretic Peptide (NT-Pro BNP) Level, Infarct Type and Infarct Volume in Ischemic Cerebrovascular Disease 缺血性脑血管病n端脑钠肽原(NT-Pro BNP)水平与梗死类型及梗死体积的关系

Journal of stroke medicine Pub Date : 2020-10-19 DOI: 10.1177/2516608520938552

S. Tekin, Çağatay Öncel, M. B. Özdemir, Y. Yaylali, Işık Tekin, Özcan Güneş, S. Rota, Nuriye Kurbetli

{"title":"Relationship Between N-Terminal Probrain Natriuretic Peptide (NT-Pro BNP) Level, Infarct Type and Infarct Volume in Ischemic Cerebrovascular Disease","authors":"S. Tekin, Çağatay Öncel, M. B. Özdemir, Y. Yaylali, Işık Tekin, Özcan Güneş, S. Rota, Nuriye Kurbetli","doi":"10.1177/2516608520938552","DOIUrl":"https://doi.org/10.1177/2516608520938552","url":null,"abstract":"Background: N-terminal probrain natriuretic peptide, which is a neurohormone produced mainly by the heart, is increased in acute ischemic cerebrovascular disease. Here we aimed to investigate the relationship of N-terminal probrain natriuretic peptide levels with cerebrovascular disease subtypes, infarct volume, and prognosis in cerebrovascular disease, and to determine if N-terminal probrain natriuretic peptide could be a biomarker for ischemic cerebrovascular disease. Methods: Consecutive 105 patients with a diagnosis of acute ischemic cerebrovascular disease and 50 healthy controls were examined for serum N-terminal probrain natriuretic peptide concentration, cerebrovascular disease subtypes, infarct volumes, and clinical outcomes with the National Institute of Health Stroke Scale assessment. Results: Mean N-terminal probrain natriuretic peptide values of cardioembolic group were significantly higher than lacunar infarct group (P < .005) and transient ischemic attack group (P = .005). There was a relation between worsening in the National Institute of Health Stroke Scale and elevation at N-terminal probrain natriuretic peptide (P = .001). However, between N-terminal probrain natriuretic peptide levels and infarct volume, significant correlation was not detected (P = .44). Conclusion: N-terminal probrain natriuretic peptide can be used as a valuable marker to distinguish between cardioembolic infarct and lacunar infarct. In addition, N-terminal probrain natriuretic peptide levels might be used as a biomarker for differential diagnosis of transient ischemic attack group and to provide insight into the prognosis.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86161353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Mental Practice Combined With Physical Practice to Enhance Upper Extremity Functional Ability Poststroke: A Systematic Review 心理训练与身体训练相结合提高中风后上肢功能能力的系统综述

Journal of stroke medicine Pub Date : 2020-10-12 DOI: 10.1177/2516608520943793

A. Alashram, G. Annino, Mohammed Al-qtaishat, E. Padua

{"title":"Mental Practice Combined With Physical Practice to Enhance Upper Extremity Functional Ability Poststroke: A Systematic Review","authors":"A. Alashram, G. Annino, Mohammed Al-qtaishat, E. Padua","doi":"10.1177/2516608520943793","DOIUrl":"https://doi.org/10.1177/2516608520943793","url":null,"abstract":"Background: Upper extremity deficits are one of the most common impairments in individuals with stroke. Mental practice is exercised cognitively in the absence of the physical trials. The effects of the combination of mental and physical practice remain unclear. Objectives: This study aimed to examine the effects of combined physical practice and mental practice on the upper extremity functional ability poststroke, to identify which stroke population is most likely to benefit from the intervention, and to determine the effective treatment dosage. Methods: We searched in the PubMed, SCOPUS, National Rehabilitation Information REHABDATA, PEDro, and Web of Science until February 2020. Randomized clinical trials examined the effects of combined physical practice and mental practice on the upper extremity functional ability in people with a stroke. The risk of bias was evaluated and the effect sizes were calculated. Results: Nine studies met our inclusion criteria. In total, 230 stroke survivors were included in this analysis (mean age: 60.84 years). This review found that combining physical practice and mental practice has beneficial effects in improving the upper extremity functional ability poststroke. Conclusion: Combining physical practice and mental practice improves the upper extremity functional ability poststroke, this improvement can extend for 3 months after the treatment intervention. We propose that using 30 to 60 min of physical practice followed by 30 min of mental practice, 2 to 3 times weekly for 6 to 10 weeks, may give meaningful effects in individuals with stroke.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84529332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 7

Predicting Recovery of Upper Extremity Motor Function After Stroke According to the NovEl Intervention Using Repetitive Transcranial Magnetic Stimulation and Occupational Therapy: NEURO 根据重复经颅磁刺激和职业疗法的新干预预测中风后上肢运动功能的恢复

Journal of stroke medicine Pub Date : 2020-06-01 DOI: 10.1177/2516608520918998

T. Hamaguchi, M. Abo, Tomoko Tanaka, K. Murata, Makoto Suzuki, N. Nakaya, K. Taguchi

{"title":"Predicting Recovery of Upper Extremity Motor Function After Stroke According to the NovEl Intervention Using Repetitive Transcranial Magnetic Stimulation and Occupational Therapy: NEURO","authors":"T. Hamaguchi, M. Abo, Tomoko Tanaka, K. Murata, Makoto Suzuki, N. Nakaya, K. Taguchi","doi":"10.1177/2516608520918998","DOIUrl":"https://doi.org/10.1177/2516608520918998","url":null,"abstract":"Abstract Background: To encourage patient goal setting and active participation in their own rehabilitation, physicians should provide patients with evidence-based prognostic predictions. Objective: This study aimed to analyze whether logarithmic time series changes in the Fugl-Meyer Assessment (FMA) score of the upper extremity (from treatment to one month after treatment) owing to NovEl intervention using repetitive transcranial magnetic stimulation and intensive occupational therapy (NEURO) conformed to logarithmic model formulae (group level), and whether the FMA score could be predicted by applying pre/posttreatment FMA scores following the model equation (individual level). Methods: This retrospective, longitudinal study included 514 poststroke paralysis patients admitted to our hospital between March 2010 and December 2018. FMA scores at 3 time points (before, after, and 4 weeks after treatment) were assessed, and conventional logarithmic regression analyses were performed to determine the time course of motor recovery. Subjects were randomly divided into 2 groups in derivation (n = 257) and validation (n = 257) analysis. Results: The time series change in the FMA score correlated with logarithmic model formulae (r2 = .97). The FMA score was substituted for the logarithmic formulae, and individual FMA scores (4 weeks after NEURO treatment) were predicted. The r2 value between the predicted and measured FMA scores was .65. Conclusions: The logarithmic model based on FMA scores before and after NEURO treatment individually predicted approximately 65% of FMA scores 4 weeks after treatment. NEURO allows the physicians to explain the prognosis to individual patients so that they can participate in their rehabilitation practices and achieve their goals.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84245425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Challenges Experienced by Physiotherapists in Rehabilitation of Individuals With Poststroke Hemineglect: A Review Study 物理治疗师在脑卒中后偏瘫患者康复中遇到的挑战:一项综述研究

Journal of stroke medicine Pub Date : 2020-06-01 DOI: 10.1177/2516608520929490

Mridul Makkar, N. Arumugam, D. Midha

{"title":"Challenges Experienced by Physiotherapists in Rehabilitation of Individuals With Poststroke Hemineglect: A Review Study","authors":"Mridul Makkar, N. Arumugam, D. Midha","doi":"10.1177/2516608520929490","DOIUrl":"https://doi.org/10.1177/2516608520929490","url":null,"abstract":"Abstract Background: Hemineglect is the inability to sense stimuli given on the paretic side. It is most frequently seen in individuals with left hemiplegia resulting from temporoparietal lobe damage. On the basis of duration poststroke, hemineglect can be acute (<3 months) or chronic (>6 months). The patients experience many challenges in rehabilitation of motor function, cognitive function, and in gaining functional independence. Aim: To identify the challenges faced by physiotherapists in rehabilitation of individuals with poststroke hemineglect. Methodology: Data Identification: An English language literature search using Google Scholar, Scopus, PubMed, and Pedro was done. Study Selection: Articles were identified and those which fulfilled the specific requirements were selected. Data Extraction: In accordance with the inclusion criteria, 9 studies done between 1997 and 2017 were reviewed. Results: In this study, we reviewed a number of studies on the treatment of hemineglect which show a variety of treatment options. The various interventions include robotic mirror therapy, repeated parietal theta-burst stimulation, low-frequency transcranial magnetic stimulation, trunk rotation and scanning training, forced use therapy, prism glass adaptation, movement detection bracelets, each of which have different effects. Conclusion: There are a limited number of studies on the different treatment methods that are currently available. Further research is needed on these treatment methods to prove their efficacy and find a suitable method to overcome the challenges that the patients with hemineglect face at present.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74579179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Management of Acute Stroke During COVID-19 Global Pandemic COVID-19全球大流行期间急性卒中的管理

Journal of stroke medicine Pub Date : 2020-06-01 DOI: 10.1177/2516608520934639

J. Pandian, I. Sebastian

引用次数: 5

Acute Onset Asymmetric Sensorimotor Paraparesis: Not Always Spinal! 急性不对称感觉运动截瘫:并不总是脊柱!

Journal of stroke medicine Pub Date : 2020-06-01 DOI: 10.1177/2516608520927198

Dhananjay Gupta, P. R, A. Mehta, M. Javali, P. T. Acharya, R. Srinivasa

{"title":"Acute Onset Asymmetric Sensorimotor Paraparesis: Not Always Spinal!","authors":"Dhananjay Gupta, P. R, A. Mehta, M. Javali, P. T. Acharya, R. Srinivasa","doi":"10.1177/2516608520927198","DOIUrl":"https://doi.org/10.1177/2516608520927198","url":null,"abstract":"Abstract Objective: To report an atypical case of acute onset sensorimotor paraparesis secondary to bilateral cerebral stroke. Background: Acute onset paraparesis or paraplegia is usually secondary to a spinal cord disease. Central or cerebral causes of paraparesis are rare and include parasagittal and bilateral precentral lesions. Design/Methods: Case report and literature review. Results: A 65-year-old man presented with acute onset weakness of both lower limbs, associated with pins and needle sensation. On examination, he was found to have paraparesis (grade 2/5, both legs) and an asymmetric sensory loss in both legs and thighs. Spinal magnetic resonance imaging ruled out any compressive or noncompressive etiology. Magnetic resonance imaging of the brain showed an acute infarction in the bilateral cerebral hemisphere in both the pre- and postcentral gyrus. An angiogram of the brain revealed an aplastic right ACA-A1 with left ACA-A1 feeding bilateral A2. There was distal left ACA-A1 stenosis seen, the probable cause of bilateral stroke in this patient. The patient was treated conservatively and showed symptomatic improvement during the course of stay at the hospital. Conclusion: This case of acute paraparesis secondary to bilateral cerebral infarction demonstrates the need to always look for a cerebral cause. In patients with cerebral infarction, who present early to a hospital, it may provide a window for thrombolytic or endovascular therapy.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79263189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Reliability of and Minimal Detectable Changes in Gait Performance Tests in Patients With Chronic Hemiplegic Stroke 慢性偏瘫卒中患者步态性能试验的可靠性和最小可检测变化

Journal of stroke medicine Pub Date : 2020-06-01 DOI: 10.1177/2516608520921104

Jun Hayakawa, Mitsuhiro Ochi, Y. Yano, R. Matsugaki, Yuto Ogata, T. Murakami, Satoshi Kuhara, H. Itoh, K. Hachisuka, S. Saeki

{"title":"Reliability of and Minimal Detectable Changes in Gait Performance Tests in Patients With Chronic Hemiplegic Stroke","authors":"Jun Hayakawa, Mitsuhiro Ochi, Y. Yano, R. Matsugaki, Yuto Ogata, T. Murakami, Satoshi Kuhara, H. Itoh, K. Hachisuka, S. Saeki","doi":"10.1177/2516608520921104","DOIUrl":"https://doi.org/10.1177/2516608520921104","url":null,"abstract":"Abstract Purpose: This study aimed to determine the inter- and intra-rater reliability of and minimal detectable changes (MDCs) at the 95% confidence interval in gait performance tests in patients with chronic hemiplegic stroke who can walk independently. Materials and Methods: Thirty patients with chronic hemiplegic stroke (24 men, 6 women, mean age 62.5 ± 11.6 years) were enrolled. Physical therapists (mean clinical experience: 9.1 ± 9.3 years) performed the timed up and go test (TUG), 10-m walk test (10MWT), and 6-min walk test (6MWT) 1 day apart. Reliability was evaluated using the intraclass correlation coefficient (ICC) and Bland–Altman analysis. Results: The ICC was ≥0.9 for all tests, and no systematic bias was found. MDC at the 95% confidence interval was 1.9 s for the TUG, 0.16 m/s for the 10MWT, and 28.4 m for the 6MWT. Discussion: We demonstrated excellent intra- and inter-rater reliability of all tests. These results suggest that gait performance tests are reliable. Conclusion: These commonly used gait performance tests demonstrated high reliability and can be recommended to evaluate clinically meaningful improvements in patients with chronic hemiplegic stroke who can walk independently.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79344181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

Comparison of Diagnostic Accuracy in Vascular Neurology Between Neurology Residents and a Neurology Differential Diagnosis App: A Multi-Center Cross-Sectional Observational Study 神经内科住院医师与神经内科鉴别诊断App对血管神经内科诊断准确性的比较:一项多中心横断面观察研究

Journal of stroke medicine Pub Date : 2020-05-20 DOI: 10.1177/2516608520901388

P. Vinny, M. Padma, P. Sylaja, P. Kesav, V. Lal, L. Narasimhan, S. Dwivedi, P. Nair, T. Iype, Anuragini Gupta, A. Patil, V. Vishnu

{"title":"Comparison of Diagnostic Accuracy in Vascular Neurology Between Neurology Residents and a Neurology Differential Diagnosis App: A Multi-Center Cross-Sectional Observational Study","authors":"P. Vinny, M. Padma, P. Sylaja, P. Kesav, V. Lal, L. Narasimhan, S. Dwivedi, P. Nair, T. Iype, Anuragini Gupta, A. Patil, V. Vishnu","doi":"10.1177/2516608520901388","DOIUrl":"https://doi.org/10.1177/2516608520901388","url":null,"abstract":"Abstract Background: Diagnostic errors in neurological diagnosis are a source of preventable harm. Software tools like Differential Diagnosis (DDx) apps in neurology that hold the potential to mitigate this harm are conspicuously lacking. Materials and Methods: A multicenter cross-sectional observational study was designed to compare the diagnostic accuracy of a Neurology DDx App (Neurology Dx) with neurology residents by using vascular neurology clinical vignettes. The study was conducted at 7 leading neurology institutes in India. Study participants comprised of 100 neurology residents from the participating institutes. Measurements: Detecting diagnostic accuracy of residents and App measured as a proportion of correctly identified high likely gold standard DDx was prespecified as the main outcome. Proportions of correctly identified first high likely, first 3 high likely, first 5 high likely, and combined moderate plus high likely gold standard differentials by residents and App were secondary outcomes. Results: 1,000 vignettes were attempted by residents. Frequency of gold standard, high likely differentials correctly identified by residents was 27% compared to 72% by App (absolute difference 45%, 95% CI 35.7-52.8). When high and moderate likely differentials were combined, residents scored 17% compared to 57% by App (absolute difference 40%, 95% CI 33.8-50.0). Residents correctly identified first high likely gold standard differential as their first high likely differential in 34% compared to 18% by App (absolute difference 16%, 95% CI 1.2-25.4). Conclusion: App with predefined knowledge base can complement clinical reasoning of neurology residents. Portability and functionality of such Apps may further strengthen this symbiosis between humans and algorithms (CTRI/2017/06/008838).","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89464837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0