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

Abstract

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.