• Stroke · Jan 2014

    Multicenter Study

    Multicenter accuracy and interobserver agreement of spot sign identification in acute intracerebral hemorrhage.

    • Thien J Huynh, Matthew L Flaherty, David J Gladstone, Joseph P Broderick, Andrew M Demchuk, Dar Dowlatshahi, Atte Meretoja, Stephen M Davis, Peter J Mitchell, George A Tomlinson, Jordan Chenkin, Tze L Chia, Sean P Symons, and Richard I Aviv.
    • From the Divisions of Neuroradiology (T.J.H., T.L.C., S.P.S., R.I.A.) and Division of Neurology, Department of Medicine, and Brain Sciences Program (D.J.G.), and Department of Emergency Medicine (J.C.), Sunnybrook Health Sciences and University of Toronto, Toronto, Canada; Department of Neurology, University of Cincinnati, OH (M.L.F., J.P.B.); Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calagary, Canada (A.M.D.); Department of Neurology, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Canada (D.D.); Departments of Medicine and Neurology (A.M., S.M.D.) and Neurointerventional Radiology (P.J.M.), Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia; and Department of Public Health Sciences, University of Toronto, Toronto, Canada (G.A.T.).
    • Stroke. 2014 Jan 1; 45 (1): 107-12.

    Background And PurposeRapid, accurate, and reliable identification of the computed tomography angiography spot sign is required to identify patients with intracerebral hemorrhage for trials of acute hemostatic therapy. We sought to assess the accuracy and interobserver agreement for spot sign identification.MethodsA total of 131 neurology, emergency medicine, and neuroradiology staff and fellows underwent imaging certification for spot sign identification before enrolling patients in 3 trials targeting spot-positive intracerebral hemorrhage for hemostatic intervention (STOP-IT, SPOTLIGHT, STOP-AUST). Ten intracerebral hemorrhage cases (spot-positive/negative ratio, 1:1) were presented for evaluation of spot sign presence, number, and mimics. True spot positivity was determined by consensus of 2 experienced neuroradiologists. Diagnostic performance, agreement, and differences by training level were analyzed.ResultsMean accuracy, sensitivity, and specificity for spot sign identification were 87%, 78%, and 96%, respectively. Overall sensitivity was lower than specificity (P<0.001) because of true spot signs incorrectly perceived as spot mimics. Interobserver agreement for spot sign presence was moderate (k=0.60). When true spots were correctly identified, 81% correctly identified the presence of single or multiple spots. Median time needed to evaluate the presence of a spot sign was 1.9 minutes (interquartile range, 1.2-3.1 minutes). Diagnostic performance, interobserver agreement, and time needed for spot sign evaluation were similar among staff physicians and fellows.ConclusionsAccuracy for spot identification is high with opportunity for improvement in spot interpretation sensitivity and interobserver agreement particularly through greater reliance on computed tomography angiography source data and awareness of limitations of multiplanar images. Further prospective study is needed.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…

What will the 'Medical Journal of You' look like?

Start your free 21 day trial now.

We guarantee your privacy. Your email address will not be shared.