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Diagnosing Suspected Stroke: A Cost-Effectiveness Analysis

Published online by Cambridge University Press:  10 March 2009

Mona Britton
Affiliation:
Department of MedicineKarolinska Institute, Danderyd HospitalStockholm
Egon Jonsson
Affiliation:
Karolinska Institute, Department of MedicineHuddinge University Hospital
Lars-Åke Marké
Affiliation:
The Swedish Planning and Rationalization Institute of the Health Services (Spri)Stockholm
Veronica Murray
Affiliation:
Department of MedicineKarolinska Institute, Danderyd HospitalStockholm

Extract

Acute cerebrovascular disease (CBVD) has an annual incidence of 100–300 per 100,000 inhabitants in the industrialized countries (1,2). CBVD occurs mainly in the elderly. Acute mortality is around 15%. Disablement and decreased quality of life are common consequences. Institutionalized care will be needed after the acute phase for around one-third of the patients (3). Considering the volume of patients and the growing proportion of elderly persons in most countries, stroke poses a major problem for health care. An effective diagnostic work-up as the base for therapy to improve the situation is, therefore, a matter of great public concern, for humanitarian as well as economic reasons.

Type
General Essays
Copyright
Copyright © Cambridge University Press 1985

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References

REFERENCES

1.Aho, K., Harmsen, P., Hatano, S., Marquardsen, J., Smirnov, V. E., & Strasser, T.Cerebrovascular disease in the community: Results of a WHO collaborative study. Bulletin of the World Health Organization, 1980, 58, 113–30.Google Scholar
2.Terént, A.A prospective epidemiological survey of cerebrovascular disease in a Swedish community. Uppsala Journal of Medical Sciences, 1979, 84, 235–46.Google Scholar
3.Ahlsiö, B., Britton, M., Murray, V., & Theorell, T.Disablement and quality of life after stroke. Stroke, 1984, 15, 886–90.Google Scholar
4.von Arbin, M., Britton, M., de Faire, U., Helmers, C., Miah, K., & Murray, V.Validation of admission criteria to a stroke unit. Journal of Chronic Diseases, 1980, 33, 215–20.CrossRefGoogle ScholarPubMed
5.von Arbin, M., Britton, M., de Faire, U., Helmers, C., Miah, K., & Murray, V., Accuracy of bedside diagnosis in stroke. Stroke, 1981, 12, 288–93.Google Scholar
6.Britton, M., Hultman, E., Murray, V., & Sjöholm, H.The diagnostic accuracy of CSF analyses in stroke. Acta Medica Scandinavica, 1983, 214, 313.Google Scholar
7.Söderström, C. E., Ericson, K., Mettinger, K. L., & Olivecrona, H.Computed tomography and CSF spectrophotometry. Diagnosis and prognosis in 300 patients with cerebrovascular disease. Scandinavian Journal of Rehabilitation Medicine, 1981, 13, 6571.Google Scholar
8.Lee, M. C., Heaney, L. M., Jacobson, R. L., & Klassen, A. C.Cerebrospinal fluid in cerebral hemorrhage and infarction. Stroke, 1975, 6, 638–41.CrossRefGoogle ScholarPubMed
9.Abrams, H. L., & McNeil, B. J.Medical implications of computed tomography (“Cat scanning”) (First of two parts). New England Journal of Medicine, 1978, 298, 255–61.CrossRefGoogle ScholarPubMed
10.Skyhöj, Olsen T., Christensen, J., Bech, Skriver E., Lassen, N. A.Brain scintigraphy with Tc99 -pertechnetate in the evaluation of patients with cerebrovascular lesions. Acta Neurologica Scandinavian, 1983, 67, 229–34.Google Scholar
11.Valdimarsson, E., Bergvall, U., & Samuelsson, K.Prognostic significance of cerebral computed tomography results in supratentorial infarction. Acta Neurologica Scandinavica, 1982, 65, 133–45.CrossRefGoogle ScholarPubMed
12.Britton, M., Hindmarsh, T., Murray, V. & Tydén, S. A.Diagnostic errors discovered by CT in patients with suspected stroke. Neurology, 1984, 34, 1504–7.Google Scholar
13.Larson, E. B., Omenn, G. S., & Loop, J. W.Computed tomography in patients with cerebrovascular disease: Impact of a new technology on patient care. American Journal of Roentgenology, 1978, 131, 3540.Google Scholar
14.Evens, R. G.Computed tomography—a controversy revisited. New England Journal of Medicine, 1984, 310, 1183–85.Google Scholar
15. Editorial. High technology medicine: A luxury we can afford? The Lancet, 1984, 2, 7778.Google Scholar
16.von Arbin, M., Britton, M., de Faire, U., Helmers, C., Miah, K., & Murray, V.A study of stroke patients treated in a non-intensive stroke unit or in general medical wards. Acta Medica Scandinavica, 1980, 208:8185.Google Scholar
17.Knaus, W. A., & Davis, D. O.Utilization and cost-effectiveness of cranial computed tomography at a university hospital. J. Computer Assisted Tomography, 1978, 2, 209–14.Google Scholar
18.Isaacs, B.Five years' experience of a stroke unit. Health Bulletin (Edinburgh) 1977, 35, 9498.Google Scholar
19.Hachinski, V., & Norris, J. W. The deteriorating stroke. In Meyer, J. S., Lechner, H., Reivich, M., Ott, E. O., & Aranibar, A. (eds.) Proceedings of the Tenth International Salzburg Conference 1980. Excerpta Medica Amsterdam-Oxford-Princeton 1981, 315–18.Google Scholar
20.Chambers, B. R., Donnan, G. A., & Bladin, P. F.Patterns of stroke. An analysis of the first 700 consecutive admissions to the Austin Hospital Stroke Unit. Australia and New Zealand Journal of Medicine, 1983, 13, 5764.Google Scholar
21.Ransohoff, D. F., & Feinstein, A. R.Problems of spectrum and bias in evaluating the efficacy of diagnostic tests. New England Journal of Medicine, 1978, 299, 926–30.Google Scholar
22.Cochrane, A. L., & Holland, W. W.Validation of screening procedures. British Medical Bulletin, 1971,27, 38.Google Scholar
23.Jonsson, E., & Marke, L-A.CT scanning in Sweden, cost-effectiveness 1981; SPRI Report 73.Google Scholar
24.Razzak, M. A., Mudarris, F., & Christie, J. H.Sensitivity of radionuclide brain imaging and computerized transaxial tomography in detecting subdural hematoma. Clinical Nuclear Medicine, 1980, 5, 154–58.Google Scholar
25.Ruff, R. L., & Dougherty, J. H. Jr., Complications of lumbar puncture followed by anticoagulation. Stroke, 1981, 12, 879–81.Google Scholar
26.Stewart, R. M., Samson, D., Diehl, J., Hinton, R., & Ditmore, Q. M.Unruptured cerebral aneurysms presenting as recurrent transient neurologic deficits. Neurology, 1980, 30, 4751.Google Scholar
27.Duffy, G. P.The “warning leak” in spontaneous subarachnoid hemorrhage. Medical Journal of Australia, 1983, 1, 514–16.Google Scholar
28.Reuben, D. B.Learning diagnostic restraint. New England Journal of Medicine, 1984, 310, 591–93.Google Scholar
29.Britton, M., & Rödén, Å. Progression of stroke after arrival at hospital. Stroke, in press.Google Scholar
30.Carter, A. B. Anticoagulant therapy. In Cerebral vascular diseases. Third Princeton conference. New York: Grune & Stratton, 1961, 151–56.Google Scholar
31.Baker, R. N., Broward, J. A., Fang, H. C. et al. , Anticoagulant therapy in cerebral infarction. Report on cooperative study. Neurology, 1962, 12, 823–35.Google Scholar
32.Terént, A.Medico-social consequences and direct costs of stroke in a Swedish community. Scandinavian Journal of Rehabilitation Medicine, 1983, 15, 165–71.Google Scholar
33.Easton, J. D., & Sherman, D. G.Management of cerebral embolism of cardiac origin. Stroke, 1980, 11, 433–42.Google Scholar
34.Dyken, M. L.Editorial: Transient ischemic attacks and aspirin, stroke and death; negative studies and type II error. Stroke, 1983, 14:24.Google Scholar
35.Wortzman, G., Holgate, R. C., & Morgan, P. P.Cranial computed tomography: an evaluation of cost effectiveness. Radiology, 1975, 117, 7577.Google Scholar
36.Bahr, A. L., & Hodges, F. J.Efficacy of computed tomography of the head in changing patient care and health costs: A retrospective study. American Journal of Roentgenology, 1978, 131:4549.Google Scholar