The Reliability of the Evaluation of Diffusion-Weighted Imaging in Suspected Stroke by Emergency Physicians

Abstract

Background Stroke is a leading cause of serious disability and death and its accurate and timely diagnosis is critical for better stroke outcomes. However, recent studies indicate that stroke is among the most common dangerous missed diagnoses. Diffusion-weighted imaging (DWI), which was first introduced in the early 1990s among clinical concerns, has become an invaluable tool in the evaluation processes of patients with suspected ischemic stroke. Objective Herein, it is aimed to investigate the reliability of the interpretation of DWI in the diagnosis of stroke by emergency physicians. Methods DWIs of the patients, evaluated in the Emergency Service of Yozgat City Hospital from April 1, 2017 to September 1, 2017, were retrospectively evaluated by four emergency physicians (specialists) separately in a blind and random fashion. The reliability of the evaluations was calculated using Kappa analyses on SPSS Statistics 20. Results DWI of 154 patients was enrolled in this study. Kappa values were determined to be as 0.911 (almost perfect), 0.909 (almost perfect), 0.897 (almost perfect), 0.779 (substantial), respectively. Discussion The results of this study may suggest that the reliability of DWI interpretation by emergency physicians was pretty high, even it can still be improved. Combining the literature data remarking a substantial number of misdiagnosed stroke patients in the emergency department (ED) and study results, it can be hypothesized that the major problem may be related with rather clinical evaluation processes as well as insufficient neurology consultation. Future reports are warranted to understand the basic problems of stroke evaluation processes in the ED. The results of these studies may aid to develop better solutions while constituting effective stroke programs and initiatives.

Differential Diagnostic Value of Machine Learning–Based Models for Embolic Stroke

“…[20][21][22] DWI is particularly noted for its sensitivity (88%-100%) and specificity (86%-100%) in the early detection of small infarcts and thus has become a valuable tool for investigating ischemic stroke [20][21][22] and is commonly used in emergency department settings. 40 Cancer-related hypercoagulability is the underlying cause of CAT in 40% of affected patients. 41 In these patients, the DWI pattern typically includes multiple lesions and arterial territories, and D-dimer levels are elevated, which may be associated with neurological deterioration, stroke recurrence, and poor survival.…”

“…20–22 DWI is particularly noted for its sensitivity (88%-100%) and specificity (86%–100%) in the early detection of small infarcts and thus has become a valuable tool for investigating ischemic stroke 20–22 and is commonly used in emergency department settings. 40…”