Agreement Among Stroke Faculty and Fellows in Treating Ischemic Stroke Patients With Tissue-Type Plasminogen Activator and Thrombectomy

作者：Ramadan Ahmad Riad^*; Denny Mary Carter; Vahidy Farhaan; Yamal Jose Miguel; Wu Tzu Ching; Sarraj Amrou; Savitz Sean; Grotta James

来源：Stroke, 2017, 48(1): 222-+.

DOI：10.1161/STROKEAHA.116.015214

• faculty
• quality improvement
• stroke
• tissue-type plasminogen activator
• thrombectomy

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 (kappa) and intraclass correlation coefficients.
Results-In 60 patients, agreement was substantial for tissue-type plasminogen activator (kappa=0.75 [95% confidence interval, 0.57-0.92]) and IAT (kappa=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 kappa 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.

• 出版日期2017-1