Clinical Diagnosis of Stroke: Need for Audit

Background: Stroke is a common disease and in developing countries its diagnosis relies heavily on clinical features because of the dearth of radiological facilities. To ensure that the diagnosis of stroke is as accurate as possible, it is imperative that clinical skills are kept at the optimum. One such method of doing this is by clinical audit. This study looked at the clinical diagnosis of stroke in a retrospective review of case notes.
Methods: The case records of patients admitted with a diagnosis of stroke into a specialist's hospital in Nigeria were reviewed. Details of historical and clinical features used in making the diagnosis and classification of stroke were recorded and compared to the standard definition and diagnostic criteria of stroke.
Results: Seventy-six of 86 case records reviewed fulfilled the criteria for a diagnosis of stroke. The features in six of the excluded cases suggested alternative diagnoses while in four cases clinical findings were conflicting. Of the 76 cases included, the recorded details were insufficient to allow for classification of stroke type in 13 cases (17.1%). Arterial territory involvement was not identified in 46 cases (61.3%) while the side of the stroke was not documented in 4 cases (5.3%). Previous diabetic status was not documented in 41 cases (53.9%), history of pre-morbid blood pressure status was not recorded in 5 cases (6.6%) and many other stroke risk factors were not established in most patients.
Conclusion: The rate possible stroke misdiagnosis in this audit project is about 7.5%. The study suggested that this could be improved upon by paying proper attention to clinical methods. Accurate diagnosis of stroke however requires radiological methods and there is a need to make these readily available even in developing countries. Secondary prevention of stroke requires the identification of all risk factors and this relies mainly on clinical methods and this audit has emphasised the need to improve on this.