Artigo Acesso aberto Revisado por pares

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

2023; Elsevier BV; Volume: 449; Linguagem: Inglês

10.1016/j.jns.2023.120646

ISSN

1878-5883

Autores

Arina Tamborska, Greta K. Wood, Erica Westenberg, David García‐Azorín, G. Webb, N. Schiess, M. Netravathi, Betül Baykan, R. Dervaj, Raimund Helbok, Suzannah Lant, A. Özge, Alessandro Padovani, Deanna Saylor, Erich Schmutzhard, Ava Easton, J.B. Lilleker, Thomas Jackson, Ettore Beghi, Mark Ellul, Jennifer Frontera, Thomas A. Pollak, Timothy R. Nicholson, Nicholas Wood, Kiran T. Thakur, Tom Solomon, Richard Stark, Andrea Sylvia Winkler, Besong Michael, Maritoni Abbariao, Shafiq Dexter Abou Zaki, Dejan Aleksić, Nicole B. Aliling, Susana Arias-Rivas, Godard Artajos, Melody Asukile, Arife Çimen Atalar, Jong Seok Bae, Chimeglkham Banzrai, Michal Bar, Valentina Barone, Betül Baykan, Ettore Beghi, Thomas Berger, Ivica Bilić, José Biller, Mateja Bošković, Verónica Cabreira, Sofia M. Calado, Maria Teresa A. Cañete, Neşe Çelebisoy, Ike Leon Chen, Lorraine Chishimba, Mashina Chomba, Glenn Anthony A. Constantino, Maria Sofia Cotelli, Harald De Cauwer, Thomas Debroucker, Luis Del Carpio-Orantes, Rashmi Devaraj, Michelle D'Souza, Esme Ekizoğlu, Ayşe Deniz Elmalı, Ana Catarina Fonseca, Roberto Furloni, Sunil Gajre, David García‐Azorín, Vanessa Garfoot, Irena Gašparić, Hamit Genç, Marinka Glavica, Luiz Gustavo Guanaes, Gizem Gürsoy, Nauman Hafiz, Buse Hasırcı, Raimund Helbok, Chee Peng Hor, Stella Hughes, Sungeun Hwang, Irem Ilgezdi Kaya, Adi Jakupi, Roland Dominic G. Jamora, Jamil Kahwagi, Ara Kaprelyan, Nfwama Kawatu, Manho Kim, Hyunji Kim, Hyun Kyung Kim, Desmond Koffie, Filipa Ladeira, Suzannah Lant, Woojin Lee, Sukyoon Lee, Zerlyn Leonardo, Christian Emmanuel Lim, Marijana Lisak, Hong Chuan Loh, Lay Khoon Loo, Arijana Lovrenčić‐Huzjan, Rosie Sue Luan Lu Koh, M. K. Luabeya, Alessandra Lugaresi, Bernadette Macrohon, Maja Rubinić Majdak, Sheryl Manalili, Filippo Manelli, Njankouo Yacouba Mapoure, Davide Mascarella, João Massano, Mataa Mataa, Jessica Leika Matibag, Alexandria Matic-Gerodias, Kate McMullen, Miguel Miranda, Margaret Modequillo, Abul Kalam Mohammed Shoab, Cristina Motto, Sinéad M. Murphy, Naluca Mwendaweli, Chen Fei Ng, Rong Xiang Ng, Mohd Khairul Nizam Nor Ihsan, Aye Myat Nyein, Karen J. O’Connell, Seong‐il Oh, Ohnmar Ohnmar, Aynur Özge, Azalea T. Pajo, Filipe Palavra, Larysa Panteleienko, Catherine Payne, Umberto Pensato, João Peres, Steven Peters, Burcu Polat, Zdravka Poljaković, Martin Punter, Liz Edenberg P. Quiles, Angelo Ranieri, M Ratković, Maria Lina Renales, José Antonio Robles, Marina Roje Bedeković, Paulus Rommer, Lidija Šapina, Helena Šarac, Deanna Saylor, Erich Schmutzhard, Anahita H. Sharma, Aleksandra Šimić, Jussi Sipilä, Dilraj Sokhi, Mauro Stagno, Kristina Stancheva, Marija Stojsavljević, Ahamed Subir, Sushee Surdhar, Loreto P. Talabucon, Hui Jan Tan, Sing Chiek Teoh, D. Cantarero Vallejo, Sibel Velioğlu, Rafaela Vukasović, Wong Wai Kit, Tamara Welte, Barbara Willekens, Nilüfer Yeşilot, Nilüfer Yeşilot, Jeryl Ritzi T. Yu, Moe Moe Zaw, Sashka Zhelyazkova, Eva Žitnik,

Tópico(s)

COVID-19 Clinical Research Studies

Resumo

Abstract Introduction 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. Methods 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). Results 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. Conclusion 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.

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