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Physician Accuracy in Determining Eligibility for Thrombolytic Therapy

David L. Schriger, MD, MPH; Mary Kalafut, MD, MS; Sidney Starkman, MD; Michelle Krueger, MD; Jeffrey L. Saver, MD

JAMA. 1998;279:1293-1297.

Context.— Intracranial hemorrhage must be excluded prior to administration of thrombolytic agents in acute stroke.

Objective.— To evaluate physician accuracy in cranial computed tomography scan interpretation for determining eligibility for thrombolytic therapy in acute stroke.

Design.— Administration of randomly selected, randomly ordered series of 15 computed tomography scans from a pool of 54 scans that demonstrated intracerebral hemorrhage, acute infarction, intracerebral calcifications (impostor for hemorrhage), old cerebral infarction (impostor for acute infarction), and normal findings.

Participants.— A convenience sample of 38 emergency physicians, 29 neurologists, and 36 general radiologists.

Main Outcome Measures.— Physician determination of eligibility for thrombolytic therapy based on computed tomography scan interpretation.

Results.— Average correct score by all physicians on all computed tomography scans was 77% (95% confidence interval, 74%-80%). Of 569 computed tomography readings by emergency physicians, 67% were correct; of 435 readings by neurologists, 83% were correct; and of 540 readings by radiologists, 83% were correct. Overall sensitivity for detecting hemorrhage was 82% (95% confidence interval, 78%-85%); 17% of emergency physicians, 40% of neurologists, and 52% of radiologists achieved 100% sensitivity for identification of hemorrhage.

Conclusion.— Physicians in this study did not uniformly achieve a level of sensitivity for identification of intracerebral hemorrhage sufficient to permit safe selection of candidates for thrombolytic therapy.

From the Emergency Medicine Center (Drs Schriger, Starkman, and Krueger) and the Department of Neurology (Drs Kalafut, Starkman, and Saver), School of Medicine, and the Stroke Center (Drs Kalafut, Starkman, and Saver), University of California at Los Angeles.

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