Computer-Aided Assessment of Transient Ischemic Attacks

Reggia, James A.; Tabb, D. Randy; Banko, Maryann; Hebel, Richard

doi:10.1001/archneur.1984.04050230030013

Cited by 37 publications

(10 citation statements)

References 16 publications

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“…For those who did not receive treatment, medical records are not obtainable. To reduce the problem of false-negative reports, alternatives using symptom questionnaires instead of a single screening question, followed by either a neurologic examination [9] or by algorithms for stroke and TIA classification [2,10], have been developed. Using a number of trigger questions, these approaches aim to capture participants who do not perceive their symptoms as of vascular etiology.…”

Section: Introductionmentioning

confidence: 99%

A Single Question about Prior Stroke versus a Stroke Questionnaire to Assess Stroke Prevalence in Populations

Berger

Hense²,

Rothdach³

et al. 2000

Neuroepidemiology

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Background: False-positive and false-negative answers to screening questions influence prevalence and incidence estimations for stroke in population studies. Despite frequent use in screening, only a few studies have examined causes and influence of incorrect self-reports. We compared the rates of false-positive and false-negative answers to a single question about prior stroke to those of the Stroke Symptom Questionnaire (SSQ), a newly developed instrument based on 6 symptom questions. Differences in stroke prevalence estimations and risk factors for incorrect reports are described. Methods: The MEMO study (Memory and Morbidity in Augsburg Elderly) examines cognitive function and neurodegenerative diseases in an elderly population (n = 384) in southern Germany. All participants filled in the symptom questionnaire, received a neurological examination and a neuropsychological test battery. Medical records were obtained for event validation of subjects positive on screening and those negative on screening with symptoms suggesting a cerebrovascular event during examination. Results: Prevalence of total stroke was 5.3% using a single screening question and 6.8% using the questionnaire. The false-negative rate was higher for the single-question approach (34.2 versus 10.5%). It was strongly influenced by gender and cognitive function. The questionnaire had a higher false-positive rate than the single question. Based on the results, we established question combinations that best served three different research scenarios (frequency estimation, risk factor analysis, control selection), relevant to stroke research in population studies. Conclusions: A single screening question for stroke in the past with event validation by medical records underestimates stroke frequency in population studies by about 30%. Use of a number of questions for key symptoms combined with a general stroke question, as in the SSQ, improves the completeness of event ascertainment and allows the detection of stroke and transient ischemic attack at the same time.

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Section: Introductionmentioning

confidence: 99%

A Single Question about Prior Stroke versus a Stroke Questionnaire to Assess Stroke Prevalence in Populations

Berger

Hense²,

Rothdach³

et al. 2000

Neuroepidemiology

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“…Reggia et al 52 constructed a computerized algorithm that agreed with physician diagnosis of TIA in 71% and with localization in 73% of 103 randomly selected TLA patients. The greatest disagreement involved patients with clinical deficits that resolved within 24 hours but who had CCT evidence of evolving infarction.…”

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confidence: 99%

The Willis lecture: transient ischemic attacks, scientific method, and new realities.

Toole

1991

Stroke

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First described by Thomas Willis in 1679 and defined in the 1950s, transient ischemic attack is universally agreed to be an episode of focal neurologic deficit in a vascular distribution, sudden in onset and resolving without residual deficit in < 2 4 hours. Transient ischemic attack is diagnosed by characteristic history and absence of residua on neurologic examination. After these criteria had been accepted, regional cerebral blood flow and computed cranial tomography in the 1970s, later positron emission tomography, and even more recently, magnetic resonance imaging reveal prolonged pathophysiologic and metabolic disturbances even in persons with all the definitional characteristics of transient ischemic attack. These persistent abnormalities necessitate reexamination of the validity of the concept of transient ischemic attack. Furthermore, our group suspects that transient ischemic attack is probably only a marker, and not itself the risk factor, for the cerebral infarction which frequently follows transient ischemic attack. Additionally, the surprising frequency with which cerebral infarction, unrecognized by patient or physician, is revealed using neuroimaging techniques has created a need to redefine the categories heretofore used for diagnosis and assessment of therapy and prognosis for transient ischemic attack and cerebral infarction. (Stroke 1991;22:99-104).

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“…hemisphere vs, brainstem) involved and have not attempted the degree of precision utilized here. Even so, the accuracy of these rule-based systems has been in the range of 50-75% (Reggia et al 1984, Spitzer et al 1989. While it is difficult to compare those efforts directly with the results obtained for the diagnostic problem-solving systems evaluated here, it is evident from the results of this study that abductive models of the type we examined can be very powerful, regardless of the plausibility criteria used.…”

Section: Discussionmentioning

confidence: 84%

An experimental study of criteria for hypothesis plausibility

Tuhrim

Reggia

Goodall

1991

Journal of Experimental & Theoretical Artificial Intelligen

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Abductive diagnostic problem-solving systems use causal relations to infer plausible diagnostic hypotheses. An important but controversial issue for such models is what characteristics should define the most plausible hypotheses. While there are theoretical predictions relevant to this issue; there are almost no empirical data on which to base rational decisions. Accordingly, this study examines four different criteria of hypothesis plausibility in diagnosing the site of brain damage in 100 medical patients. The criteria examined are (1) naive minimal cardinality, (2) irredundancy, (3) most probable (Bayesian), and (4) minimal cardinality when adjacency relations are taken into account. Model performance when these different hypothesis plausibility criteria are used confirms the previously predicted inadequacy of minimal cardinality. It also indicates that irredundancy ('minimality'), the criterion most widely used in current AI models, is not useful in this setting because of the large number of alternative, implausible hypotheses it produces. The most interesting result is that a modified minimal cardinality criterion produces the best hypotheses when measured as the ratio of agreements with human experts per hypothesis generated. In addition, comparing the results of this study to two previous rule-based systems for a similar application indicates that abductive diagnostic systems can be very powerful as application programs. These results, useful in themselves, underscore the need for more systematic empirical studies of abductive problem-solving models.

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Computer-Aided Assessment of Transient Ischemic Attacks

Cited by 37 publications

References 16 publications

A Single Question about Prior Stroke versus a Stroke Questionnaire to Assess Stroke Prevalence in Populations

A Single Question about Prior Stroke versus a Stroke Questionnaire to Assess Stroke Prevalence in Populations

The Willis lecture: transient ischemic attacks, scientific method, and new realities.

An experimental study of criteria for hypothesis plausibility

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