Out-of-hospital diagnosis of cerebral infarction versus intracranial hemorrhage

Woisetschläger, C.; Kittler, H.; Oschatz, E.; Bur, A.; Lang, W.; Waldenhofer, U.; Laggner, A.N.; Hirschl, M. M.
October 2000
Intensive Care Medicine;Oct2000, Vol. 26 Issue 10, p1561
Academic Journal
Objective: To establish a model based on clinical and anamnestic data easily available in the out-of-hospital setting, which facilitates the differential diagnosis between cerebral infarction and intracranial hemorrhage. Design: Retrospective study that simulates a prospective approach. Setting: Emergency Department of the University Hospital in Vienna, Austria. Patients and participants: Data of 224 patients with either intracranial hemorrhage or cerebral infarction were prospectively collected. Uni- and multivariate analysis was performed to identify neurological symptoms and anamnestic data, which were associated with either intracranial hemorrhage or cerebral infarction. Measurements and results: Unilateral weakness or sensory loss was observed more frequently in patients with infarction compared to hemorrhage (69.8% vs 11.9%, P<0.001). The frequency of patients with impaired level of consciousness was significantly higher in the hemorrhage group compared to the infarction group (59.3% vs 3.8%, P<0.001). A multivariate logistic regression analysis showed that hypertension (OR=0.31, 95% CI= 0.12–0.76, P=0.01), diabetes (OR=0.17, 95% CI=0.04–0.68, P=0.01), and unilateral weakness or sensory loss (OR=0.10, 95% CI=0.04–0.26, P<0.001) were significantly associated with cerebral infarction. Impaired level of consciousness was significantly related to hemorrhage (OR=13.41, 95% CI=3.92–45.91, P<0.001). On the basis of the logistic regression analysis, we generated a scoring system for the out-of-hospital diagnosis between infarction and hemorrhage. The values of the score lay between –3 and +3. The probability of infarction increases when the score becomes negative, and the probability for hemorrhage increases when the score becomes positive. Conclusion: Our model is a useful guideline for the differential diagnosis between cerebral infarction and intracranial hemorrhage in the out-of-hospital setting, as it is based on easily available clinical and anamnestic parameters.


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