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Ovid Technologies (Wolters Kluwer Health)
Stroke Vascular and Interventional Neurology
,  volume 5 ,  issue 2

How Good Are Neurologists? A Diagnostic Accuracy Study on the Performance of Neurologists in the Emergency Room

Christoph J. Schankin 1, 2, 3
, 
Bianca‐Violeta Popa‐Todirenchi 1, 2, 3
, 
Anne‐Sophie Eich 1, 2, 3
, 
Mattia Branca 4, 5
, 
Aikaterini Galimanis 1, 2, 3
, 
Adrian Scutelnic 1, 2, 3
, 
Martina B Goeldlin 1, 2, 3
, 
Morin Beyeler 1, 2, 3
, 
Aristomenis Exadaktylos 2, 3, 6
, 
Nebiyat Belachew 3, 7, 8
, 
Mirjam R. Heldner 1, 2, 3
, 
Johannes Kaesmacher 3, 7, 8
, 
Thomas R Meinel 1, 2, 3
, 
Heinrich P Mattle 1, 2, 3
, 
Simon Jung 1, 2, 3
, 
Marwan El-Koussy 3, 7, 8
, 
Urs Fischer 1, 2, 3, 9, 10
1
 
2
 
3
 
4
 
5
 
6
 
7
 
8
 
University Hospital
9
 
10
 
Publication type: Journal Article
Publication date: 2025-03-01
Ovid Technologies (Wolters Kluwer Health)
wos Q2
SJR: —
CiteScore: —
Impact factor: 2.8
ISSN: 26945746
Abstract
BACKGROUND
In people with suspected stroke the first assessment occurs under time pressure in the emergency department and is based solely on clinical information. Working hypotheses include mechanism and localization of the clinical deficit on imaging. To assess the performance of neurologists in such situation, we investigated the accuracy with which board‐certified neurologists make the correct diagnosis based solely on clinical information.
METHODS
In this prospective diagnostic accuracy study done at an emergency department of a university hospital, neurologists had to commit themselves to a diagnosis in people with suspected acute stroke. The main analysis was the accuracy with which they distinguished vascular from nonvascular causes using the discharge diagnosis as a reference. Secondary analyses included the distinction of ischemic from hemorrhagic strokes, and the accuracy with which the lesion location and site of vessel occlusion were identified. The performance of neurologists was also compared to residents and medical students.
RESULTS
Of 800 people with suspected stroke, 567 (71%) had a vascular (508 ischemic stroke or transient ischemic attack and 59 hemorrhagic stroke) and 233 (29%) had a nonvascular disorder (72 seizures, 33 migraine auras, 12 functional neurological disorders, and 116 other diseases). Vessel occlusion was found in 227 of 410 people with ischemic stroke. Neurologists identified vascular origin with an accuracy of 0.86 (95% CI: 0.83–0.89), a sensitivity of 0.93 (0.90–0.95), and a specificity of 0.66 (0.58–0.73). The accuracy to identify ischemia compared with hemorrhage was 0.91 (0.87–0.93). Neurologists’ accuracy to predict the presence of vessel occlusion was 0.66 (0.61–0.71), of exact lesion location was 42%, and of the affected blood vessel 57%.
CONCLUSION
In people with acute neurological deficits, the accuracy with which neurologists identify vascular origin is high and depends on neurological education. Experienced physicians should be involved early in the management of people with “code stroke.”
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Schankin C. J. et al. How Good Are Neurologists? A Diagnostic Accuracy Study on the Performance of Neurologists in the Emergency Room // Stroke Vascular and Interventional Neurology. 2025. Vol. 5. No. 2.
GOST all authors (up to 50) Copy
Schankin C. J. et al. How Good Are Neurologists? A Diagnostic Accuracy Study on the Performance of Neurologists in the Emergency Room // Stroke Vascular and Interventional Neurology. 2025. Vol. 5. No. 2.
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TY - JOUR
DO - 10.1161/svin.124.001612
UR - https://www.ahajournals.org/doi/10.1161/SVIN.124.001612
TI - How Good Are Neurologists? A Diagnostic Accuracy Study on the Performance of Neurologists in the Emergency Room
T2 - Stroke Vascular and Interventional Neurology
AU - Schankin, Christoph J.
AU - Popa‐Todirenchi, Bianca‐Violeta
AU - Eich, Anne‐Sophie
AU - Branca, Mattia
AU - Galimanis, Aikaterini
AU - Scutelnic, Adrian
AU - Goeldlin, Martina B
AU - Beyeler, Morin
AU - Exadaktylos, Aristomenis
AU - Belachew, Nebiyat
AU - Heldner, Mirjam R.
AU - Kaesmacher, Johannes
AU - Meinel, Thomas R
AU - Mattle, Heinrich P
AU - Jung, Simon
AU - El-Koussy, Marwan
AU - Fischer, Urs
PY - 2025
DA - 2025/03/01
PB - Ovid Technologies (Wolters Kluwer Health)
IS - 2
VL - 5
SN - 2694-5746
ER -
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Cite this
BibTex (up to 50 authors) Copy
@article{2025_Schankin,
author = {Christoph J. Schankin and Bianca‐Violeta Popa‐Todirenchi and Anne‐Sophie Eich and Mattia Branca and Aikaterini Galimanis and Adrian Scutelnic and Martina B Goeldlin and Morin Beyeler and Aristomenis Exadaktylos and Nebiyat Belachew and Mirjam R. Heldner and Johannes Kaesmacher and Thomas R Meinel and Heinrich P Mattle and Simon Jung and Marwan El-Koussy and Urs Fischer and others},
title = {How Good Are Neurologists? A Diagnostic Accuracy Study on the Performance of Neurologists in the Emergency Room},
journal = {Stroke Vascular and Interventional Neurology},
year = {2025},
volume = {5},
publisher = {Ovid Technologies (Wolters Kluwer Health)},
month = {mar},
url = {https://www.ahajournals.org/doi/10.1161/SVIN.124.001612},
number = {2},
doi = {10.1161/svin.124.001612}
}