Cranial computed tomography interpretation in acute stroke: physician accuracy in determining eligibility for thrombolytic therapy

JAMA. 1998 Apr;279(16):1293-7. doi: 10.1001/jama.279.16.1293.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Brain / diagnostic imaging
  • Cerebral Hemorrhage / diagnostic imaging*
  • Cerebral Infarction / diagnostic imaging
  • Cerebrovascular Disorders / diagnostic imaging*
  • Cerebrovascular Disorders / drug therapy*
  • Clinical Competence / statistics & numerical data*
  • Emergency Medicine / standards
  • Hospitals, University
  • Humans
  • Logistic Models
  • Neurology / standards
  • Patient Selection
  • Physicians / standards*
  • Physicians / statistics & numerical data
  • Radiology / standards
  • Sensitivity and Specificity
  • Thrombolytic Therapy*
  • Tomography, X-Ray Computed*
  • United States