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

Abstract

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.

Advances in differential diagnosis of cerebrovascular diseases in magnetic resonance imaging: a narrative review

“…The patients may develop into strokes, especially shortly after a TIA attack. To prevent strokes in patients with TIA, urgent evaluation and intervention should be performed (74,75).…”

“…However, MRI may show evidence of an infarct or hemorrhage to rule out a TIA or to identify the reason of TIA, such as carotid plaques (80). In inpatients, MRI is the most sensitive imaging method of detecting TIA or minor stroke; acute DWI hyperintense lesions on brain MRI can match 29.3% patients with a clinical diagnosis of TIA (74). However, the hyperintensity on DWI decreases after 10 days and totally disappears at 2-3 weeks after the original attack.…”

Incidência e prognóstico de ataque isquêmico transitório no Brasil: um estudo de base populacional

“…A primeira ferramenta -escore de Dawson -é uma ferramenta clínica, desenhada para um contexto de especialistas neurovasculares, composta por 9 variáveis preditoras, porem que não teve um bom desempenho no contexto de atenção primária, e também falhou em considerar eventos retinianos ou de circulação posterior em seu desenho -estatística C de 0,70 (DAWSON et al, 2009;FITZPATRICK et al, 2019). Em contrapartida, a ferramenta DOTS leva em consideração 17 variáveis preditoras, com desempenho mais satisfatório que a primeira (especificidade de 76% (IC 70-81%) e sensibilidade 89% (FITZPATRICK et al, 2019;YUAN et al, 2019). Nenhuma delas é perfeita, porém algumas são mais acuradas que outras, e podem significar um avanço no reconhecimento do AIT na prática clinica do emergencista (FITZPATRICK et al, 2019).…”

“…Apesar de informações ainda incompletas, já há um corpo de evidências que permitiria acionar as autoridades em saúde para que olhem com mais atenção a esta problemática, e já tomem medidas cabíveis para melhoria deste cenário. (FITZPATRICK et al, 2019;YUAN et al, 2019) TABELA 11…”