Evaluation of brain computed tomography and brain magnetic resonance images of patients admitted to the emergency department with stroke clinic by emergency medi̇cal assistants

Introduction and aim Rapid and accurate diagnosis in emergency department patients presenting with stroke is crucial for starting appropriate treatment in a timely manner. This study aims to compare the evaluation skills of emergency medicine residents in interpreting brain computed tomography (CT) and brain diffusion-weighted magnetic resonance imaging (DW-MRI) of patients presenting to the emergency department with a preliminary diagnosis of ischemic stroke, against those of a radiology specialist. Material and Methods: The study was conducted in the Department of Emergency Medicine at Karadeniz Technical University Faculty of Medicine. Images of patients who presented to the emergency department with stroke symptoms between January 1, 2022, and June 1, 2022, and had brain CT and DW-MRI as indicated, were collected. Then, the images were evaluated by 30 emergency medicine residents an one radiology specialist, unaware of the patients' clinical information. Emergency medicine residents were given 2 hours of training on evaluating brain CT and DW-MRI by the radiology specialist. Groups containing 15 normal and 15 pathological CT and 15 normal and 15 pathological DW-MRI images were created for each resident to evaluate, with the radiological images of the included patients being randomized. The evaluation focused on the presence of early ischemic signs in brain CT, diffusion restriction in DW-MRI, its localization, which artery supply area it belonged to, and the presence of diffusion-flair mismatch. The agreement between the emergency medicine resident and the radiology specialist was assessed using Kappa analysis. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were also calculated. Results: In the study, the sensitivity of emergency medicine residents in identifying early ischemic signs on brain CT was found to be 59% and specificity 84%, with moderate agreement with radiology (Cohen kappa: 0.427). In evaluating DW-MRI for diffusion restriction, sensitivity was 89% and specificity 91%, with good agreement with radiology (Cohen kappa: 0.802). Conclusion: Our study shows that emergency medicine residents have high agreement with radiology specialists in detecting infarcts in DW-MRI but perform less well in identifying localization, artery supply area, diffusion-flair mismatch, and early ischemic signs in brain CT. Performance was higher among senior residents compared to juniors. Improvement of results requires more theoretical and practical training. Keywords: Emergency Medicine, Ischemic Stroke, Brain CT, Brain MRI