Out-of-hospital diagnosis of cerebral infarction versus intracranial hemorrhage

Intensive Care Med. 2000 Oct;26(10):1561-5. doi: 10.1007/s001340000663.

Abstract

Objective: To establish a model based on clinical and anamnestic data easily available in the out-of-hospital setting, which facilitates the differential diagnosis between cerebral infarction and intracranial hemorrhage.

Design: Retrospective study that simulates a prospective approach.

Setting: Emergency Department of the University Hospital in Vienna, Austria.

Patients and participants: Data of 224 patients with either intracranial hemorrhage or cerebral infarction were prospectively collected. Uni-and multivariate analysis was performed to identify neurological symptoms and anamnestic data, which were associated with either intracranial hemorrhage or cerebral infarction.

Measurements and results: Unilateral weakness or sensory loss was observed more frequently in patients with infarction compared to hemorrhage (69.8 % vs 11.9 %, P < 0.001). The frequency of patients with impaired level of consciousness was significantly higher in the hemorrhage group compared to the infarction group (59.3 % vs 3.8 %, P < 0.001). A multivariate logistic regression analysis showed that hypertension (OR = 0.31, 95 % CI = 0.12-0.76, P = 0.01), diabetes (OR = 0.17, 95% CI = 0.04-0.68, P = 0.01), and unilateral weakness or sensory loss (OR = 0.10, 95 % CI = 0.04-0.26, P < 0.001) were significantly associated with cerebral infarction. Impaired level of consciousness was significantly related to hemorrhage (OR = 13.41, 95 % CI = 3.92-45.91, P < 0.001). On the basis of the logistic regression analysis, we generated a scoring system for the out-of-hospital diagnosis between infarction and hemorrhage. The values of the score lay between -3 and +3. The probability of infarction increases when the score becomes negative, and the probability for hemorrhage increases when the score becomes positive.

Conclusion: Our model is a useful guideline for the differential diagnosis between cerebral infarction and intracranial hemorrhage in the out-of-hospital setting, as it is based on easily available clinical and anamnestic parameters.

Publication types

  • Validation Study

MeSH terms

  • Aged
  • Cerebral Infarction / diagnosis*
  • Cerebral Infarction / etiology
  • Coma / etiology
  • Diabetes Complications
  • Diagnosis, Differential
  • Emergency Medical Services / methods*
  • Emergency Medical Services / standards
  • Hemiplegia / etiology
  • Humans
  • Hypertension / complications
  • Intracranial Hemorrhages / diagnosis*
  • Intracranial Hemorrhages / etiology
  • Logistic Models
  • Male
  • Medical History Taking / methods
  • Middle Aged
  • Multivariate Analysis
  • Physical Examination / methods
  • Practice Guidelines as Topic
  • Prognosis
  • Prospective Studies
  • Retrospective Studies
  • Risk Factors
  • Sensitivity and Specificity
  • Severity of Illness Index*
  • Tomography, X-Ray Computed