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Letters | September 22/29, 2010

Distinguishing Hemorrhagic Stroke From Ischemic Stroke

Ashwini Kalantri, MBBS; Shriprakash Kalantri, MD, MPH

JAMA. 2010;304(12):1327-1328. doi:10.1001/jama.2010.1341.

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To the Editor: In their Rational Clinical Examination article, Drs Runchey and McGee¹ summarized the diagnostic accuracy of clinical findings and different stroke scores in distinguishing hemorrhagic and ischemic strokes. The pretest probability (prevalence) of hemorrhagic stroke in the selected studies was 24% (1528 of 6438 patients). A Siriraj score lower than −1 (likelihood ratio [LR], 0.29; 95% confidence interval [CI], 0.23-0.37) or clinician overall impression that hemorrhage is unlikely (LR, 0.28; 95% CI, 0.20-0.39) would decrease the probability of hemorrhage from 24% to 8%, reducing the diagnostic uncertainty but not lowering the likelihood of hemorrhage to a point at which further diagnostic evaluation by neuroimaging may be unnecessary.

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September 22, 2010

Distinguishing Hemorrhagic Stroke From Ischemic Stroke—Reply

Shauna Runchey, MD, MPH; Steven McGee, MD

JAMA. 2010;304(12):1327-1328. doi:10.1001/jama.2010.1342.

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Kalantri A, Kalantri S. Distinguishing Hemorrhagic Stroke From Ischemic Stroke. JAMA. 2010;304(12):1327-1328. doi:10.1001/jama.2010.1341.

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