Introduction: MRI has emerged as the gold standard for confirming the diagnosis of acute ischemic stroke (AIS). This resulted in an increase in the number of MRIs ordered which in turn may influence neurology residents to rely on imaging for the diagnosis of AIS at the expense of their clinical skills.
Objectives: 1) To assess the clinical accuracy of residents in the initial evaluation of the potential stroke patient. 2) To investigate different variables in the patient’s clinical picture that influences the clinical diagnosis of residents, and determine if these variables are predictive of the ultimate diagnosis of AIS.
Methods: The study period was from July 2014 to May 2015. Neurology residents at SUNY Buffalo were requested to complete online questionnaires for potential stroke patients wherein a brain MRI was ordered. Questionnaire included preliminary clinical diagnosis made by the resident (stroke yes or no) and on what clinical basis was the diagnosis made. MRI reports were later reviewed and compared to residents’ clinical diagnosis. Chi-square test was used in data analysis.
Results: A total of 231 brain MRIs were ordered. Resident’s clinical diagnosis was correct in 191 Patients (accuracy = 83%, p <0.001). Accuracy per PGY level was calculated to be 80%, 79% and 93% for PGY2, 3 and 4 respectively (p< 0.001). Embolic risk factors and cortical stroke signs were the variables used by residents which correctly had the highest association with positive MRI finding, 85%. Functional patients and history of seizure disorder were variables used by residents which correctly had the highest association with negative MRI results, 100 and 89% respectively. Residents’ clinical evaluation was incorrect in 26% of patients with history of previous stroke.
Conclusion: Neurology residents at our institution are accurate in their initial clinical assessment of potential stroke patients prior to MRI results greater than 80% of the time. PGY4s performed better, while PGY2 and 3 performed at the same level which needs further studies. Variables in clinical presentation such as functional symptoms and history of seizure were most helpful to our residents. Patients with history of previous stroke were the most challenging for our residents to evaluate.