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(Stroke. 1998;29:1106-1109.)
© 1998 American Heart Association, Inc.

Original Contributions

Diagnosis of Stroke by the Nonneurologist

A Validation Study

J. M. Ferro, MD, PhD; A. N. Pinto, MD; I. Falcão, MD; G. Rodrigues, MD; J. Ferreira, MD; F. Falcão, MD; E. Azevedo, MD; P. Canhão, MD; T. P. Melo, MD; M. J. Rosas, MD; V. Oliveira, MD; A. V. Salgado, MD

From the Department of Neurology, Hospital de Santa Maria (J.M.F., J.F., F.F., P.C., T.P., V.O.), and the Epidemiology Division (I.F.), Direcção Geral da Saúde, Lisbon, Portugal; Centro de Saúde de Ponte de Sor (G.R.) network Médicos-Sentinela; Department of Neurology, Hospital Fernando da Fonseca (A.N.P., A.V.S.), Amadora, Portugal; and Department of Neurology, Hospital de São João (E.A, M.J.R.), Porto, Portugal.

Correspondence to José M. Ferro, Serviço de Neurologia, Hospital de Santa Maria, 160 0 Lisboa, Portugal. E-mail jferro{at}mail.telepac.pt

Background and Purpose—The first medical contact of an acute stroke victim is often a nonneurologist. Validation of stroke diagnosis made by these medical doctors is poorly known. The present study seeks to validate the stroke diagnoses made by general practitioners (GPs) and hospital emergency service physicians (ESPs).

Methods—Validation through direct interview and examination by a neurologist was performed for diagnoses of stroke made by GPs in patients under their care and doctors working at the emergency departments of 3 hospitals.

Results—Validation of the GP diagnosis was confirmed in 44 cases (85%); 3 patients (6%) had transient ischemic attacks and 5 (9%) suffered from noncerebrovascular disorders. Validation of the ESP diagnosis was confirmed in 169 patients (91%); 16 (9%) had a noncerebrovascular diagnosis. Overall, the most frequent conditions misdiagnosed as stroke were neurological in nature (cerebral tumor, 3; subdural hematoma, 1; seizure, 1; benign paroxysmal postural vertigo, 1; peripheral facial palsy, 2; psychiatric condition, 6; and other medical disorders, 7).

Conclusions—In the majority of cases, nonneurologists (either GPs or ESPs) can make a correct diagnosis of acute stroke. Treatment of acute stroke with drugs that do not cause serious side effects can be started before evaluation by a neurologist and CT scan.

Key Words: cerebral ischemia • diagnosis • emergency room services • observer variation • stroke

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