National Survey of Neurologists for Transient Ischemic Attack Risk Stratification Consensus and Appropriate Treatment for a Given Level of Risks

Perry, Jeffrey J.; Losier, Justin H; Stiell, Ian G.; Sharma, Mukul; Abdulaziz, Kasim E

doi:10.1016/j.jstrokecerebrovasdis.2015.06.034

Cited by 3 publications

(3 citation statements)

References 27 publications

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“…We had previously surveyed both neurologists and emergency physicians to identify thresholds of stroke risk that would alter clinical decisions 2627. In these studies, respondents indicated that patients with a subsequent risk of stroke below 1% were most appropriate for outpatient investigation, whereas patients with a subsequent risk of stroke above 5% constitute a high risk group that might benefit from comprehensive investigation, more intensive therapy, and possible admission at the time of the initial emergency department visit.…”

Section: Discussionmentioning

confidence: 99%

“…The interval likelihood ratio is the multilevel extension of the positive and negative likelihood ratios, which are applicable only when a test/risk score is dichotomised into two levels (positive versus negative or high risk versus low risk). We pre-specified risk thresholds (low risk <1%, medium risk 1-5%, and high risk >5%) on the basis of previous surveys of emergency physicians and neurologists to group discrete risk scores into these three risk levels 2627. We calculated the sensitivity and specificity when the score was dichotomised at each integer value from −3 to 23.…”

Section: Methodsmentioning

confidence: 99%

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Prospective validation of Canadian TIA Score and comparison with ABCD2 and ABCD2i for subsequent stroke risk after transient ischaemic attack: multicentre prospective cohort study

Perry

Sivilotti

Émond

et al. 2021

BMJ

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Objective To validate the previously derived Canadian TIA Score to stratify subsequent stroke risk in a new cohort of emergency department patients with transient ischaemic attack. Design Prospective cohort study. Setting 13 Canadian emergency departments over five years. Participants 7607 consecutively enrolled adult patients attending the emergency department with transient ischaemic attack or minor stroke. Main outcome measures The primary outcome was subsequent stroke or carotid endarterectomy/carotid artery stenting within seven days. The secondary outcome was subsequent stroke within seven days (with or without carotid endarterectomy/carotid artery stenting). Telephone follow-up used the validated Questionnaire for Verifying Stroke Free Status at seven and 90 days. All outcomes were adjudicated by panels of three stroke experts, blinded to the index emergency department visit. Results Of the 7607 patients, 108 (1.4%) had a subsequent stroke within seven days, 83 (1.1%) had carotid endarterectomy/carotid artery stenting within seven days, and nine had both. The Canadian TIA Score stratified the risk of stroke, carotid endarterectomy/carotid artery stenting, or both within seven days as low (risk ≤0.5%; interval likelihood ratio 0.20, 95% confidence interval 0.09 to 0.44), medium (risk 2.3%; interval likelihood ratio 0.94, 0.85 to 1.04), and high (risk 5.9% interval likelihood ratio 2.56, 2.02 to 3.25) more accurately (area under the curve 0.70, 95% confidence interval 0.66 to 0.73) than did the ABCD2 (0.60, 0.55 to 0.64) or ABCD2i (0.64, 0.59 to 0.68). Results were similar for subsequent stroke regardless of carotid endarterectomy/carotid artery stenting within seven days. Conclusion The Canadian TIA Score stratifies patients’ seven day risk for stroke, with or without carotid endarterectomy/carotid artery stenting, and is now ready for clinical use. Incorporating this validated risk estimate into management plans should improve early decision making at the index emergency visit regarding benefits of hospital admission, timing of investigations, and prioritisation of specialist referral.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Prospective validation of Canadian TIA Score and comparison with ABCD2 and ABCD2i for subsequent stroke risk after transient ischaemic attack: multicentre prospective cohort study

Perry

Sivilotti

Émond

et al. 2021

BMJ

Self Cite

View full text Add to dashboard Cite

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“…4,5 The urgency and level of care provided for TIA patients often depends on the perceived risk of subsequent major stroke. 6,7 Traditionally, and still in some parts of the world, TIA patients were admitted to hospital for rapid investigation and comprehensive management. 8 In an effort to optimize health resource utilization with improved patient outcomes, outpatient-based models have been introduced.…”

Section: Introductionmentioning

confidence: 99%

Practice Variation among Canadian Stroke Prevention Clinics: Pre, During, and Post-COVID-19

Abdulaziz

Taljaard

Dowlatshahi

et al. 2022

Can. J. Neurol. Sci.

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Background: Stroke is a common and serious disorder. With optimal care, 90-day recurrent stroke risk can be reduced from 10% to about 1%. Stroke prevention clinics (SPCs) can improve patient outcomes and resource allocation but lack standardization in patient management. The extent of variation in patient management among SPCs is unknown. Our aims were to assess baseline practice variation between Canadian SPCs and the impact of COVID-19 on SPC patient care. Methods: We conducted an electronic survey of 80 SPCs across Canada from May to November 2021. SPC leads were contacted by email with up to five reminders. Results: Of 80 SPCs contacted, 76 were eligible from which 38 (50.0%) responded. The majority (65.8%) of SPCs are open 5 or more days a week. Tests are more likely to be completed before the SPC visit if referrals were from clinic’s own emergency department compared to other referring sources. COVID-19 had a negative impact on routine patient care including longer wait times (increased for 36.4% clinics) and higher number of patients without completed bloodwork prior to arriving for appointments (increased for 27.3% clinics). During COVID-19 pandemic, 87.9% of SPCs provided virtual care while 72.7% plan to continue with virtual care post-COVID-19 pandemic. Conclusion: Despite the time-sensitive nature of transient ischemic attack patient management, some SPCs in Canada are not able to see patients quickly. SPCs should endeavor to implement strategies so that they can see high-risk patients within the highest risk timeline and implement strategies to complete some tests while waiting for SPC appointment.

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Derivation of a clinical prediction score for the diagnosis of clinically significant symptomatic carotid artery disease

Abdulaziz,

Taljaard,

Dowlatshahi

et al. 2024

Can J Emerg Med

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National Survey of Neurologists for Transient Ischemic Attack Risk Stratification Consensus and Appropriate Treatment for a Given Level of Risks

Cited by 3 publications

References 27 publications

Prospective validation of Canadian TIA Score and comparison with ABCD2 and ABCD2i for subsequent stroke risk after transient ischaemic attack: multicentre prospective cohort study

Prospective validation of Canadian TIA Score and comparison with ABCD2 and ABCD2i for subsequent stroke risk after transient ischaemic attack: multicentre prospective cohort study

Practice Variation among Canadian Stroke Prevention Clinics: Pre, During, and Post-COVID-19

Derivation of a clinical prediction score for the diagnosis of clinically significant symptomatic carotid artery disease

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