Application Value Of Clinical Symptoms For The Clinician’s First Diagnosis Of Cerebral Infarction

Objective:to explore the relationship between clinical symptoms of patients with cerebral infarction and first diagnosis of clinicians as well as the diagnosis value of such symptoms, and to evaluate the consistency between clinician’s first diagnosis and DWI diagnosis.Methods:1122patients randomly selected from a teaching hospital were diagnosed by brain unenhanced and DWI from May2009to March2012,19were excluded according included criteria, and finally1103were used statistical analysis sample. Research contents included clinical symptoms of patients with cerebral infarction, clinician’s first diagnosis and DWI diagnosis. Paired chi-square test was used to evaluate the consistency between clinician’s first diagnosis and DWI diagnosis; fisher exact probability, chi-square test and logistic regression model were used to explore the relationship between clinical symptoms of patients with cerebral infarction and first diagnosis of clinicians. Selected DWI diagnosis as a golden standard, diagnosis test assessment was used to evaluate the value for diagnosis cerebral infarction with main clinical symptoms. All analyses with two-sided hypothesis test were performed using SPSS version17.0. The significant level was a=0.05.Results:A total of1103patients were included in this study. The diagnosis consistency probability between clinician’s first diagnosis and DWI diagnosis was76.5%(95%CI:73.9%,78.9%),. When the patients were diagnosed as positive by clinicians, the positive probability was85.3%(95%CI:82.7%,87.6%) by DWI diagnosis. At the same time, when the patients were diagnosed as negative by clinicians, the negative probability was51.2%(95%CI:45.4%,57.0%),and kappa coefficient was0.374(P=0.000), which showed that there moderate diagnosis consistency probability between two kinds of diagnosis. Univariate analysis showed cerebral infarction by first diagnosis for clinicians was significantly associated with barriers to physical activity (x2=41.763, P=0.000), limb weakness(x2=52.348,P=0.000), dizziness (x2=48.615, P=0.000), giddiness(x2=18.679,P=0.000), slurred speech (x2=44.297, P=0.000), headache(x2=20.656,P=0.000), and Twitch (P=0.002). Multivariate analysis also showed that cerebral infarction first diagnosis for clinicians was significantly associated with barriers to physical activity (OR:5.97;95CI:3.14-11.34), limb weakness (OR:3.44,95%CI:2.26-5.23), slurred speech (OR:3.52,95%CI:1.91-6.49). The sensitivity, specialty and positive predict value of physical activity applying in the clinician’s first diagnosis were93.7%(95%CI:89.3%,96.4%)0.0%and97.3%(95%CI:93.8%,98.8%, respectively, and92.0%(95%CI:88.4%,94.5%),28.9%(95%CI:17.7%,43.4%),90.0%(95%CI:86.2%,92.8%) for limb weakness, and94.8%(95%CI:90.7%,97.2%),20.0%(95%CI:7.1%,45.2%),93.8%(95%CI:89.5%,96.4%) for slurred speech, respectively.Conclusion:There was moderate total consistency probability between clinician’s first diagnosis and DWI diagnosis for cerebral infarction. Clinician’s first diagnosis of cerebral infarction was significantly associated with clinical symptoms, such as physical activity, limb weakness, and slurred speech. And those clinical symptoms are useful for diagnosis on cerebral infarction with high level of the sensitivity and positive predict value.