TY - JOUR
T1 - Global uncertainty in the diagnosis of neurological complications of SARS-CoV-2 infection by both neurologists and non-neurologists
T2 - An international inter-observer variability study
AU - Global NeuroResearch Coalition
AU - Tamborska, A A
AU - Wood, G K
AU - Westenberg, E
AU - Garcia-Azorin, D
AU - Webb, G
AU - Schiess, N
AU - Netravathi, M
AU - Baykan, B
AU - Dervaj, R
AU - Helbok, R
AU - Lant, S
AU - Özge, A
AU - Padovani, A
AU - Saylor, D
AU - Schmutzhard, E
AU - Easton, A
AU - Lilleker, J B
AU - Jackson, T
AU - Beghi, E
AU - Ellul, M A
AU - Frontera, J A
AU - Pollak, T
AU - Nicholson, T R
AU - Wood, N
AU - Thakur, K T
AU - Solomon, T
AU - Stark, R J
AU - Winkler, A S
AU - Michael, B D
N1 - Copyright © 2023 Elsevier B.V. All rights reserved.
PY - 2023/6/15
Y1 - 2023/6/15
N2 - 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.
AB - 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.
KW - Humans
KW - COVID-19/complications
KW - SARS-CoV-2
KW - Observer Variation
KW - Uncertainty
KW - Nervous System Diseases/etiology
KW - Encephalitis/complications
KW - Headache/diagnosis
KW - Guillain-Barre Syndrome/diagnosis
KW - COVID-19 Testing
U2 - 10.1016/j.jns.2023.120646
DO - 10.1016/j.jns.2023.120646
M3 - Article
C2 - 37100018
SN - 0022-510X
VL - 449
JO - Journal of the Neurological Sciences
JF - Journal of the Neurological Sciences
M1 - 120646
ER -
