Do Clinicians Overestimate the Severity of Intracerebral Hemorrhage?
Do Clinicians Overestimate the Severity of Intracerebral Hemorrhage?
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DOI：
10.1161/strokeaha.118.022606
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发表时间：
2019-02-01
期刊：
影响因子：
8.3
通讯作者：
Muir, Keith W.
中科院分区：
文献类型：
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作者：
Tilling, Elliot J.;El Tawil, Salwa;Muir, Keith W.
背景和目的-脑出血(ICH)比急性缺血性中风(AIS)预后更差。然而，临床医生对预后的看法可能会影响治疗决策，并对预后产生不利影响。在急性CT上，与AIS相比，ICH的显着性可能会导致临床医生高估病情并影响预后评估。我们调查了临床医生对急性脑出血和急性脑梗塞的体积、严重程度和预后的估计是否不同。方法回顾急性脑出血或缺血性卒中患者的CT扫描。使用ABC/2方法计算体积，并通过专门的成像软件进行自动体积分析。ICH病例与AIS病例在病变体积上相匹配，根据急性(6小时)CT诊断脑出血，24小时CT诊断AIS。在不了解临床信息的情况下，临床医生将病变体积估计到最接近的5毫升，将病变严重程度从1级(轻度)分级到5级(非常严重)，并使用改良的兰金量表估计30天的预后。结果-我们比较了33例脑出血患者和33例容量匹配的AIS患者。临床医生高估了脑出血量，低估了AIS量：脑出血和AIS的平均差值(估计-实际体积)分别为+8毫升(+/-30)和-8毫升(+/-27)(P
Background and Purpose-Intracerebral hemorrhage (ICH) has a poorer prognosis than acute ischemic stroke (AIS). However, clinician perception of prognosis may influence treatment decisions and adversely affect outcome. On acute CT, the conspicuity of ICH compared with AIS may lead clinicians to overestimate severity and influence prognostic evaluation. We investigated whether clinicians' estimates of volume, severity, and prognosis from acute imaging differed between ICH and AIS.Methods-CT scans from participants with acute ICH or ischemic stroke were reviewed. Volume was calculated using the ABC/2 method and automated volumetric analysis via specialized imaging software. ICH cases were matched with AIS cases for lesion volume, based on acute (< 6 hours) CT for ICH, and 24-hour CT for AIS. Blind to clinical information, clinicians estimated lesion volume to the nearest 5 mL, graded lesion severity from 1 (mild) to 5 (very severe), and estimated 30-day prognosis using the modified Rankin Scale.Results-We compared 33 ICH cases with 33 volume-matched AIS cases. Clinicians overestimated ICH volume and underestimated AIS volumes: mean differences (estimated-actual volume) were + 8 mL (+/- 30) for ICH and -8 mL (+/- 27) for AIS (P