Key result
Clinical findings such as coma (LR 6.2; 95% CI 3.2-12) and neck stiffness (LR 5.0) increase the probability of hemorrhagic stroke, but diagnostic certainty requires neuroimaging.
Why the study?
Does clinical examination accurately distinguish hemorrhagic stroke from ischemic stroke in adult patients with acute stroke?
Population
19 prospective studies pooling 6,438 adult patients with acute stroke (n=1528 [24%] with hemorrhagic stroke)
Comparison
Initial clinical examination findings vs Accepted diagnostic standards of hemorrhagic…
Design
Systematic_review
Authors
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Clinical signs refine hemorrhage probability but cannot supplant imaging; confirms exam's adjunctive role in acute stroke differentiation.
Systematic Review (n=6,438)
Does clinical examination accurately distinguish hemorrhagic stroke from ischemic stroke in adult patients with acute stroke?
Effect estimate: LR 6.2 (95% CI 3.2-12)
Certain clinical findings can increase or decrease the probability of intracranial hemorrhage in acute stroke, but neuroimaging remains required for definitive diagnosis.
Runchey et al. (2010) conducted a systematic review in acute stroke (n=6,438). Clinical examination findings (e.g., coma, neck stiffness, Siriraj score) vs. Absence of findings / Ischemic stroke was evaluated on Diagnostic accuracy for hemorrhagic stroke (LR 6.2, 95% CI 3.2-12). Clinical findings such as coma (LR 6.2; 95% CI 3.2-12) and neck stiffness (LR 5.0) increase the probability of hemorrhagic stroke, but diagnostic certainty requires neuroimaging.
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