ABCD3-I score and the risk of early or 3-month stroke recurrence in tissue- and time-based definitions of TIA and minor stroke

Mayer, Lukas; Ferrari, Julia; Krebs, Stefan; Boehme, Christian; Toell, Thomas; Matosevic, Benjamin; Tinchon, Alexander; Brainin, Michael; Gattringer, Thomas; Sommer, Peter; Thun, Peter; Willeit, Johann; Lang, Wilfried; Kiechl, Stefan; Knoflach, Michael

doi:10.1007/s00415-017-8720-8

Cited by 22 publications

(18 citation statements)

References 13 publications

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“…The term “transient neurological symptoms” is used to describe a broad spectrum of symptoms following TIA or TIA mimics (20). Unilateral weakness and speech disturbances are the most common clinical manifestations of TIA, and our findings were in accordance with the prior studies (21, 22). It was reported unilateral weakness and speech disturbance were found in ~31–54% and 25–42% of TIA, respectively (5).…”

Section: Discussionsupporting

confidence: 94%

External Validation of the Diagnosis of TIA (DOT) Score for Identification of TIA in a Chinese Population

et al. 2019

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Background: Recently, the [diagnosis of transient ischemic attack (TIA), DOT] score has been recognized to be a new tool for non-specialists to diagnose TIA more accurately with the sensitivity and specificity being 89 and 76%, respectively. However, the DOT score has not yet been validated externally in patients with TIA in China. Methods: We retrospectively enrolled 500 consecutive patients with transient neurological symptoms, who were admitted to the Department of Neurology, Beijing Chaoyang Hospital and underwent magnetic resonance imaging (MRI) between Jan 2016 and Dec 2018. Patients with transient neurological symptoms were divided into two subgroups: TIA mimic group ( N = 140, 28%) and definite cerebrovascular events group including tissue-based TIA (DWI negative, N = 252, 50.4%) and minor stroke (DWI positive, N = 108, 21.6%). The demographic data, clinical characteristics, laboratory findings, and scores of Dawson and DOT were compared between the two groups. Results: A total of 500 patients with transient neurological symptoms (mean age, 61.1 ± 12.8) were enrolled and 70% ( N = 350) were male. Comparing with TIA mimic groups, patients with cerebrovascular events group were more likely to have higher diastolic blood pressure, uric acid and homocysteine, more motor weakness and speech abnormalities, and also scored higher using the Dawson and DOT. The area under the curve (AUC) was 0.728 for DOT, with a sensitivity of 70.3% and specificity of 62.9%, respectively. Conclusion: In patients with transient neurological symptoms, our findings showed that the DOT score had relatively good calibration and discrimination to identify of TIA in a Chinese Population. As a novel tool of TIA identification, further validations are needed in multiple centers with larger samples in China.

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Section: Discussionsupporting

confidence: 94%

External Validation of the Diagnosis of TIA (DOT) Score for Identification of TIA in a Chinese Population

et al. 2019

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“…In the population of Spain, the area under the ROC curve of ABCD2 and ABCD3-I for ischemic events prediction were 0.49 and 0.77 [31]. Recently, the ABCD3-I score performed equally in TIA patients in tissue-as well as time-based definition and the same for minor stroke patients [22]. Our study was also in line with the above studies.…”

Section: Discussionsupporting

confidence: 90%

“…The term of 'transient neurological symptoms' is used to describe the broad spectrum of symptoms following TIA or TIA mimics. Unilateral weakness and speech disturbances are the most common manifestations of TIA [22]. It was reported unilateral weakness and speech disturbance were found in approximately 31%-54% and 25%-42% of TIA, respectively [18].…”

Section: Discussionmentioning

confidence: 98%

Validation and comparison of Diagnosis of TIA (DOT) score as a new clinical diagnostic tool for patients with a clinical diagnosis of transient ischemic attack in China

Jia¹,

Song²,

Yuan³

2019

Preprint

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Background: Recently, [the diagnosis of transient ischemic attack (TIA), DOT) score was considered to be a new tool for non-specialists to diagnose TIA more accurately with the sensitivity and specificity were 89% and 76%. However, the DOT score has not yet been validated externally in patients with TIA in China. Methods: We prospectively enrolled consecutive 500 patients with transient neurological symptoms, who were admitted to our hospital and underwent magnetic resonance imaging (MRI) during hospitalization between Jan 2016 and Dec 2018. Patients with transient neurological symptoms were divided into two subgroups: TIA mimic group (N=140, 28%) and definite cerebrovascular events group (including tissue-based TIA (N=252, 50.4%) and minor stroke (N=108, 21.6%)). The demographic data, clinical characteristics, laboratory findings and scores of ABCD2, ABCD3-I, Dawson and DOT were compared between the two groups. Results: A total of 500 patients with transient neurological symptoms (mean age, 61.1±12.8) were enrolled and 70% (N=350) were male. Comparing with TIA mimic groups, patients with definite cerebrovascular events group were correlated with higher diastolic blood pressure, higher proportion of motor weakness and speech abnormalities, the higher levels of uric acid and homocysteine, and the scores of ABCD2, ABCD3-I, Dawson, and DOT. The logistic regression analysis showed diastolic blood pressure (OR 1.026, CI 1.006-1.046, P=0.011), ABCD3-I (OR 1.219, CI 1.032-1.440, P=0.020) and DOT (OR 1.462, CI 1.305-1.637, P=0.001) were independently predicted the occurrence of definite cerebrovascular events. The score of DOT showed the greatest area under the ROC curve (AUC=0.728), with a sensitivity of 70.3% and specificity of 62.9%, respectively. The optimal cut point for DOT was 0.455 using the Youden Index. Conclusion: Our findings showed DOT score performed relatively good calibration and discrimination. As a novel tool of TIA, further validations are needed externally in patients with TIA with multiple centers in large samples in China.

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“…These new scoring systems have been well validated in other populations, reporting the c-statistics of 0.60–0.64 in predicting the recurrent stroke within 3 month following TIA. However, new scores such as ABCD 3 -I score have not been recommended for risk stratification in such patients by the guidelines by far (10, 11).…”

Section: Introductionmentioning

confidence: 99%

Early Identification of High-Risk TIA or Minor Stroke Using Artificial Neural Network

et al. 2019

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Background and Purpose: The risk of recurrent stroke following a transient ischemic attack (TIA) or minor stroke is high, despite of a significant reduction in the past decade. In this study, we investigated the feasibility of using artificial neural network (ANN) for risk stratification of TIA or minor stroke patients. Methods: Consecutive patients with acute TIA or minor ischemic stroke presenting at a tertiary hospital during a 2-year period were recruited. We collected demographics, clinical and imaging data at baseline. The primary outcome was recurrent ischemic stroke within 1 year. We developed ANN models to predict the primary outcome. We randomly down-sampled patients without a primary outcome to 1:1 match with those with a primary outcome to mitigate data imbalance. We used a 5-fold cross-validation approach to train and test the ANN models to avoid overfitting. We employed 19 independent variables at baseline as the input neurons in the ANN models, using a learning algorithm based on backpropagation to minimize the loss function. We obtained the sensitivity, specificity, accuracy and the c statistic of each ANN model from the 5 rounds of cross-validation and compared that of support vector machine (SVM) and Naïve Bayes classifier in risk stratification of the patients. Results: A total of 451 acute TIA or minor stroke patients were enrolled. Forty (8.9%) patients had a recurrent ischemic stroke within 1 year. Another 40 patients were randomly selected from those with no recurrent stroke, so that data from 80 patients in total were used for 5 rounds of training and testing of ANN models. The median sensitivity, specificity, accuracy and c statistic of the ANN models to predict recurrent stroke at 1 year was 75%, 75%, 75%, and 0.77, respectively. ANN model outperformed SVM and Naïve Bayes classifier in our dataset for predicting relapse after TIA or minor stroke. Conclusion: This pilot study indicated that ANN may yield a novel and effective method in risk stratification of TIA and minor stroke. Further studies are warranted for verification and improvement of the current ANN model.

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ABCD3-I score and the risk of early or 3-month stroke recurrence in tissue- and time-based definitions of TIA and minor stroke

Cited by 22 publications

References 13 publications

External Validation of the Diagnosis of TIA (DOT) Score for Identification of TIA in a Chinese Population

External Validation of the Diagnosis of TIA (DOT) Score for Identification of TIA in a Chinese Population

Validation and comparison of Diagnosis of TIA (DOT) score as a new clinical diagnostic tool for patients with a clinical diagnosis of transient ischemic attack in China

Early Identification of High-Risk TIA or Minor Stroke Using Artificial Neural Network

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