Ahmad-Riad Ramadan1, Mary Carter Denny2, Farhaan Vahidy2, Jose-Miguel Yamal2, Tzu-Ching Wu2, Amrou Sarraj2, Sean Savitz2, James Grotta2. 1. From the Department of Neurology, University of Texas Health Science Center at Houston (A.-R.R., M.C.D., F.V., T.-C.W., A.S., S.S.); Department of Biostatistics, University of Texas School of Public Health, Houston (J.-M.Y.); and Stroke Research, Memorial Hermann Hospital, Houston, TX (J.G.). ahmad.riad.ramadan@gmail.com. 2. From the Department of Neurology, University of Texas Health Science Center at Houston (A.-R.R., M.C.D., F.V., T.-C.W., A.S., S.S.); Department of Biostatistics, University of Texas School of Public Health, Houston (J.-M.Y.); and Stroke Research, Memorial Hermann Hospital, Houston, TX (J.G.).
Abstract
BACKGROUND AND PURPOSE: The aim of this study is to determine agreement among vascular neurology fellows and faculty in treating patients with acute ischemic stroke with intravenous tissue-type plasminogen activator and intra-arterial thrombectomy (IAT). METHODS: Patients were evaluated simultaneously by at least 2 vascular neurology. Agreement was determined using kappa (κ) and intraclass correlation coefficients. RESULTS: In 60 patients, agreement was substantial for tissue-type plasminogen activator (κ=0.75 [95% confidence interval, 0.57-0.92]) and IAT (κ=0.63 [95% confidence interval, 0.30-0.96]), with no difference between fellow-fellow versus fellow-faculty. Intraclass correlation coefficient for National Institutes of Health Stroke Scale was 0.94 (95% confidence interval, 0.90-0.97) and κ for Alberta Stroke Program Early CT Score was 0.53 (95% confidence interval, 0.20-0.78). Rapidly improving or mild deficits caused disagreement for both tissue-type plasminogen activator and IAT, whereas interpretation of computed tomographic perfusion led to disagreement for IAT. CONCLUSIONS: We found substantial agreement between vascular neurology fellows and faculty in treating with tissue-type plasminogen activator or IAT. Areas for improvement include recognition of stroke mimics, consensus on treating less severe strokes, and use/interpretation of imaging.
BACKGROUND AND PURPOSE: The aim of this study is to determine agreement among vascular neurology fellows and faculty in treating patients with acute ischemic stroke with intravenous tissue-type plasminogen activator and intra-arterial thrombectomy (IAT). METHODS:Patients were evaluated simultaneously by at least 2 vascular neurology. Agreement was determined using kappa (κ) and intraclass correlation coefficients. RESULTS: In 60 patients, agreement was substantial for tissue-type plasminogen activator (κ=0.75 [95% confidence interval, 0.57-0.92]) and IAT (κ=0.63 [95% confidence interval, 0.30-0.96]), with no difference between fellow-fellow versus fellow-faculty. Intraclass correlation coefficient for National Institutes of Health Stroke Scale was 0.94 (95% confidence interval, 0.90-0.97) and κ for Alberta Stroke Program Early CT Score was 0.53 (95% confidence interval, 0.20-0.78). Rapidly improving or mild deficits caused disagreement for both tissue-type plasminogen activator and IAT, whereas interpretation of computed tomographic perfusion led to disagreement for IAT. CONCLUSIONS: We found substantial agreement between vascular neurology fellows and faculty in treating with tissue-type plasminogen activator or IAT. Areas for improvement include recognition of stroke mimics, consensus on treating less severe strokes, and use/interpretation of imaging.
Authors: Ketevan Berekashvili; Alicia M Zha; Mohammed Abdel-Al; Xu Zhang; Jazba H Soomro; Samuel J Prater; James C Grotta Journal: Stroke Date: 2019-11-27 Impact factor: 7.914