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January 6, 1999

Reducing Treatment Delay and Improving Diagnostic Accuracy for Patients With Acute Stroke—Reply

Author Affiliations

Margaret A.Winker, MDIndividualAuthorPhil B.FontanarosaMD, Senior EditorsIndividualAuthor

JAMA. 1999;281(1):31-34. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-1-jbk0106

In Reply: Drs Mines and Rosenzweig point out that the case mix of easy and difficult scans will greatly influence average performance and that our subjects' average performance may not be representative of these subjects' average performance on a series of scans of patients presenting in the community. While we suspect that intracerebral hemorrhages that are difficult to diagnose are less common in community practice than in our study, our study did not include other forms of intracranial bleeding (small epidural hematomas, chronic subdural hematomas, and subarachnoid bleeds) that may be more challenging to detect. Our collection of acute cerebral infarction scans included "easy" ones seldom seen in patients who meet criteria for thrombolysis (presenting within 3 hours of symptom onset). Therefore, the average difficulty of the infarctions shown to our subjects was likely much lower than the average difficulty of infarction scans seen in practice. Overall, we are uncertain whether our scan pool's case mix was harder or easier than that of a series of actual cases seen in the community. As an initial investigation, our study focused on characterizing the physicians' ability to interpret various kinds of scans rather than on measuring exact "actual practice" performance. We agree that better characterization of actual performance would be worthwhile.