Tamborska, AA 
ORCID: 0000-0003-4661-8407, Wood, GK ORCID: 0000-0001-6098-2331, Westenberg, E, Garcia-Azorin, D, Webb, G, Schiess, N, Netravathi, M, Baykan, B, Dervaj, R, Helbok, R et al (show 19 more authors)
(2023)
Global uncertainty in the diagnosis of neurological complications of SARS-CoV-2 infection by both neurologists and non-neurologists: An international inter-observer variability study.
JOURNAL OF THE NEUROLOGICAL SCIENCES, 449.
120646-.
Abstract
<h4>Introduction</h4>Uniform case definitions are required to ensure harmonised reporting of neurological syndromes associated with SARS-CoV-2. Moreover, it is unclear how clinicians perceive the relative importance of SARS-CoV-2 in neurological syndromes, which risks under- or over-reporting.<h4>Methods</h4>We invited clinicians through global networks, including the World Federation of Neurology, to assess ten anonymised vignettes of SARS-CoV-2 neurological syndromes. Using standardised case definitions, clinicians assigned a diagnosis and ranked association with SARS-CoV-2. We compared diagnostic accuracy and assigned association ranks between different settings and specialties and calculated inter-rater agreement for case definitions as "poor" (κ ≤ 0.4), "moderate" or "good" (κ > 0.6).<h4>Results</h4>1265 diagnoses were assigned by 146 participants from 45 countries on six continents. The highest correct proportion were cerebral venous sinus thrombosis (CVST, 95.8%), Guillain-Barré syndrome (GBS, 92.4%) and headache (91.6%) and the lowest encephalitis (72.8%), psychosis (53.8%) and encephalopathy (43.2%). Diagnostic accuracy was similar between neurologists and non-neurologists (median score 8 vs. 7/10, p = 0.1). Good inter-rater agreement was observed for five diagnoses: cranial neuropathy, headache, myelitis, CVST, and GBS and poor agreement for encephalopathy. In 13% of vignettes, clinicians incorrectly assigned lowest association ranks, regardless of setting and specialty.<h4>Conclusion</h4>The case definitions can help with reporting of neurological complications of SARS-CoV-2, also in settings with few neurologists. However, encephalopathy, encephalitis, and psychosis were often misdiagnosed, and clinicians underestimated the association with SARS-CoV-2. Future work should refine the case definitions and provide training if global reporting of neurological syndromes associated with SARS-CoV-2 is to be robust.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | SARS-CoV-2, Neurology, Diagnosis, Inter-rater agreement |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Infection, Veterinary and Ecological Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 31 May 2023 12:11 |
| Last Modified: | 02 Jul 2023 00:21 |
| DOI: | 10.1016/j.jns.2023.120646 |
| Open Access URL: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10085... |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3170765 |
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