scholarly journals Diagnostic Accuracy of the Explicit Diagnostic Criteria for Transient Ischemic Attack

Stroke ◽  
2019 ◽  
Vol 50 (8) ◽  
pp. 2080-2085 ◽  
Author(s):  
L. Servaas Dolmans ◽  
Elena R. Lebedeva ◽  
Dinusha Veluponnar ◽  
Ewoud J. van Dijk ◽  
Paul J. Nederkoorn ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Diagnostic Criteria ◽  
Clinical Diagnosis ◽  
Clinical Features ◽  
Transient Ischemic Attack ◽  
Predictive Value ◽  
Minor Stroke ◽  
Clinical Tool ◽  
Predictive Values ◽  
Ischemic Attack

Background and Purpose— The clinical diagnosis of a transient ischemic attack (TIA) can be difficult. Evidence-based criteria hardly exist. We evaluated if the recently proposed Explicit Diagnostic Criteria for TIA (EDCT), an easy to perform clinical tool focusing on type, duration, and mode of onset of clinical features, would facilitate the clinical diagnosis of TIA. Methods— We used data from patients suspected of a TIA by a general practitioner and referred to a TIA service in the region of Utrecht, the Netherlands, who participated in the MIND-TIA (Markers in the Diagnosis of TIA) study. Information about the clinical features was collected with a standardized questionnaire within 72 hours after onset. A panel of 3 experienced neurologists ultimately determined the definite diagnosis based on all available diagnostic information including a 6-month follow-up period. Two researchers scored the EDCT. Sensitivity, specificity, and predictive values of the EDCT were assessed using the panel diagnosis as reference. A secondary analysis was performed with modified subcriteria of the EDCT. Results— Of the 206 patients, 126 (61%) had a TIA (n=104) or minor stroke (n=22), and 80 (39%) an alternative diagnosis. Most common alternative diagnoses were migraine with aura (n=24; 30.0%), stress related or somatoform symptoms (n=16; 20.0%), and syncope (n=9; 11.3%). The original EDCT had a sensitivity of 98.4% (95% CI, 94.4–99.8) and a specificity of 61.3% (49.7–71.9). Negative and positive predictive values were 96.1% (86.0–99.0) and 80.0% (75.2–84.1), respectively. The modified EDCT showed a higher specificity of 73.8% (62.7–83.0) with the same sensitivity and a similar negative predictive value of 96.7%, but a higher positive predictive value of 85.5% (80.3–89.5). Conclusions— The EDCT has excellent sensitivity and negative predictive value and could be a valuable diagnostic tool for the diagnosis of TIA.

scholarly journals Reliability of Clinical Diagnosis of the Symptomatic Vascular Territory in Patients With Recent Transient Ischemic Attack or Minor Stroke

Stroke ◽  
2008 ◽  
Vol 39 (9) ◽  
pp. 2457-2460 ◽  
Author(s):  
Enrico Flossmann ◽  
Jessica N. Redgrave ◽  
Dennis Briley ◽  
Peter M. Rothwell
Keyword(s):  
Clinical Diagnosis ◽  
Transient Ischemic Attack ◽  
Minor Stroke ◽  
Vascular Territory ◽  
Ischemic Attack

Abstract T MP116: Coated-Platelets Predict Stroke at 30 days in Patients with Transient Ischemic Attack

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Angelia Kirkpatrick ◽  
Andrea Vincent ◽  
George Dale ◽  
Calin Prodan
Keyword(s):  
Negative Predictive Value ◽  
Transient Ischemic Attack ◽  
Predictive Value ◽  
Roc Analysis ◽  
Characteristic Curve ◽  
Neurological Dysfunction ◽  
Stroke Recurrence ◽  
Normal Brain ◽  
Lacunar Stroke ◽  
Ischemic Attack

Background: Coated-platelets, a subset of procoagulant platelets observed upon dual agonist stimulation with collagen and thrombin, support a robust prothrombinase activity and provide a unique measure of platelet thrombotic potential. Coated-platelet levels are increased both in non-lacunar stroke and transient ischemic attack (TIA) compared to controls free of stroke or TIA. In addition, higher levels in non-lacunar stroke are associated with stroke recurrence. We now examine whether coated-platelet levels predict stroke at 30 days in TIA patients. Methods: Consecutive patients with a diagnosis of TIA established by a board certified neurologist were enrolled in this pilot study. The diagnosis was consistent with the tissue-based definition of TIA: a transient episode of neurological dysfunction without acute infarction. The absence of infarction was demonstrated by normal brain imaging studies. Those taking anticoagulants or with dementia were excluded. Coated-platelets were determined at baseline and reported as percent of cells converted to coated-platelets. A receiver operating characteristic curve (ROC) analysis was conducted to compare the ability of coated-platelets versus chance alone to predict incident stroke at 30 days. Results: We enrolled 171 patients. Ten strokes were observed at 30 days. ROC analysis showed significant improvement in the predictive ability of the coated-platelets model compared to chance (AUC: 0.78 ± 0.07 versus 0.50 ± 0, respectively; p < 0.0001). A cut-off of 51.1% for coated-platelet levels yielded a sensitivity of 0.80 (0.55-1.0; 95% CI), specificity of 0.73 (0.66-0.80), positive predictive value of 0.16 (0.06-0.26), and a negative predictive value of 0.98 (0.96-1.0). Conclusions: Among these subjects with TIA, coated platelet levels <51.1% at time of presentation had a negative predictive value of 98% for stroke at 30 days. These findings suggest a role for coated-platelets in stroke risk stratification following TIA.

381 Role of CT scans of abdomen and pelvis in management of patients with immunotherapy-induced colitis

2020 ◽  
Vol 8 (Suppl 3) ◽  
pp. A406-A406
Author(s):  
Juan Ibarra Rovira ◽  
Raghunandan Vikram ◽  
Selvi Thirumurthi ◽  
Bulent Yilmaz ◽  
Heather Lin ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Clinical Diagnosis ◽  
Predictive Value ◽  
Clinical Symptoms ◽  
Cytotoxic T Lymphocyte ◽  
Checkpoint Inhibitors ◽  
Ct Scans ◽  
Wall Thickening ◽  
Low Sensitivity ◽  
Sensitivity Specificity

BackgroundColitis is one of the most common immune-related adverse event in patients who receive immune checkpoint inhibitors targeting cytotoxic T-lymphocyte antigen 4 (CTLA-4) and programmed cell death-1 (PD-1). Although radiographic changes are reported on computed tomography such as mild diffuse bowel thickening or segmental colitis, the utility of CT in diagnosis of patients with suspected immune-related colitis is not well studied.MethodsCT scans of the abdomen and pelvis of 34 patients on immunotherapy with a clinical diagnosis of immunotherapy induced colitis and 19 patients receiving immunotherapy without clinical symptoms of colitis (control) were enrolled in this retrospective study. Segments of the colon (rectum, sigmoid, descending, transverse, ascending and cecum) were assessed independently by two fellowship trained abdominal imaging specialists with 7 and 13 years‘ experience who were blinded to the clinical diagnosis. Each segment was assessed for mucosal enhancement, wall thickening, distension, peri-serosal fat stranding. Any disagreements were resolved in consensus. The degree of distension and the spurious assignment of wall thickening were the most common causes for disagreement. The presence of any of the signs was considered as radiographic evidence of colitis.ResultsCT evidence of colitis was seen in 16 of 34 patients with symptoms of colitis. 7 of 19 patients who did not have symptoms of colitis showed signs of colitis on CT. The sensitivity, specificity, Positive Predictive Value and Negative Predictive Value for colitis on CT is 47%, 63.2%, 69.5% and 40%, respectively.ConclusionsCT has a low sensitivity, specificity and negative predictive value for the diagnosis of immunotherapy-induced colitis. CT has no role in the diagnosis of patients suspected of having uncomplicated immune-related colitis and should not be used routinely for management.Trial RegistrationThis protocol is not registered on clinicaltrials.gov.Ethics ApprovalThis protocol was IRB approved on: 11/16/2015 - IRB 4 Chair Designee FWA #: 00000363 OHRP IRB Registration Number: IRB 4 IRB00005015ConsentThis protocol utilizes an IRB approved waiver of consent.

scholarly journals Screening for aneurysms of the abdominal aorta using a simple screening device

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
J. W. Brakel ◽  
T. A. Berendsen ◽  
P. M. C. Callenbach ◽  
J. van der Burgh ◽  
R. J. Hissink ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Sensitivity And Specificity ◽  
Abdominal Aorta ◽  
Predictive Value ◽  
Cost Effective ◽  
Abdominal Ultrasound ◽  
Predictive Values ◽  
Bladder Scan ◽  
Health Council ◽  
Screening Device

Abstract Introduction Several countries advocate screening for aneurysms of the abdominal aorta (AAA) in selected patients. In the Netherlands, routine screening is currently under review by the National Health Council. In any screening programme, cost-efficiency and accuracy are key. In this study, we evaluate the Aorta Scan (Verathon, Amsterdam, Netherlands), a cost-effective and easy-to-use screening device based on bladder scan technology, which enables untrained personnel to screen for AAA. Methods We subjected 117 patients to an Aorta Scan and compared the results to the gold standard (abdominal ultrasound). We used statistical analysis to determine sensitivity and specificity of the Aorta Scan, as well as the positive and negative predictive values, accuracy, and inter-test agreement (Kappa). Results Sensitivity and specificity were 0.86 and 0.98, respectively. Positive predictive value was 0.98 and negative predictive value was 0.88. Accuracy was determined at 0.92 and the Kappa value was 0.85. When waist–hip circumferences (WHC) of > 115 cm were excluded, sensitivity raised to 0.96, specificity stayed 0.98, positive and negative predictive value were 0.98 and 0.96, respectively, accuracy to 0.97, and Kappa to 0.94. Conclusion Herein, we show that the Aorta Scan is a cost-effective and very accurate screening tool, especially in patients with WHC below 115 cm, which makes it a suitable candidate for implementation into clinical practice, specifically in the setting of screening selected populations for the presence of AAA.

scholarly journals Foundational Statistical Principles in Medical Research: Sensitivity, Specificity, Positive Predictive Value, and Negative Predictive Value

Medicina ◽  
2021 ◽  
Vol 57 (5) ◽  
pp. 503
Author(s):  
Thomas F. Monaghan ◽  
Syed N. Rahman ◽  
Christina W. Agudelo ◽  
Alan J. Wein ◽  
Jason M. Lazar ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Medical Literature ◽  
Disease Prevalence ◽  
Positive Test Result ◽  
Predictive Values ◽  
Sensitivity Specificity ◽  
Test Result ◽  
Test Probability

Sensitivity, which denotes the proportion of subjects correctly given a positive assignment out of all subjects who are actually positive for the outcome, indicates how well a test can classify subjects who truly have the outcome of interest. Specificity, which denotes the proportion of subjects correctly given a negative assignment out of all subjects who are actually negative for the outcome, indicates how well a test can classify subjects who truly do not have the outcome of interest. Positive predictive value reflects the proportion of subjects with a positive test result who truly have the outcome of interest. Negative predictive value reflects the proportion of subjects with a negative test result who truly do not have the outcome of interest. Sensitivity and specificity are inversely related, wherein one increases as the other decreases, but are generally considered stable for a given test, whereas positive and negative predictive values do inherently vary with pre-test probability (e.g., changes in population disease prevalence). This article will further detail the concepts of sensitivity, specificity, and predictive values using a recent real-world example from the medical literature.

scholarly journals Does Abnormal Circadian Blood Pressure Pattern Really Matter in Patients With Transient Ischemic Attack or Minor Stroke?

Stroke ◽  
2014 ◽  
Vol 45 (3) ◽  
pp. 865-867 ◽  
Author(s):  
WenWen Zhang ◽  
Dominique A. Cadilhac ◽  
Leonid Churilov ◽  
Geoffrey A. Donnan ◽  
Christopher O’Callaghan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Transient Ischemic Attack ◽  
Minor Stroke ◽  
Pressure Pattern ◽  
Circadian Blood Pressure ◽  
Ischemic Attack

scholarly journals Sensitivity and Negative Predictive Value of Motor Evoked Potentials of the Facial Nerve

2021 ◽  
Author(s):  
Nicolas Bovo ◽  
Shahan Momjian ◽  
Renato Gondar ◽  
Philippe Bijlenga ◽  
Karl Schaller ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Evoked Potentials ◽  
Negative Predictive Value ◽  
Patient Group ◽  
Vestibular Schwannoma ◽  
Predictive Value ◽  
Cerebellopontine Angle ◽  
Motor Evoked Potentials ◽  
Vestibular Schwannomas ◽  
Predictive Values

Abstract Objective The objective of this study was to determine the performance of the standard alarm criterion of motor evoked potentials (MEPs) of the facial nerve in surgeries performed for resections of vestibular schwannomas or of other lesions of the cerebellopontine angle. Methods This retrospective study included 33 patients (16 with vestibular schwannomas and 17 with other lesions) who underwent the resection surgery with transcranial MEPs of the facial nerve. A reproducible 50% decrease in MEP amplitude, resistant to a 10% increase in stimulation intensity, was applied as the alarm criterion during surgery. Facial muscular function was clinically evaluated with the House–Brackmann score (HBS), pre- and postsurgery at 3 months. Results In the patient group with vestibular schwannoma, postoperatively, the highest sensitivity and negative predictive values were found for a 30% decrease in MEP amplitude, that is, a criterion stricter than the 50% decrease in MEP amplitude criterion, prone to trigger more warnings, used intraoperatively. With this new criterion, the sensitivity would be 88.9% and the negative predictive value would be 85.7%. In the patient group with other lesions of the cerebellopontine angle, the highest sensitivity and negative predictive values were found equally for 50, 60, or 70% decrease in MEP amplitude. With these criteria, the sensitivities and the negative predictive values would be 100.0%. Conclusion Different alarm criteria were found for surgeries for vestibular schwannomas and for other lesions of the cerebellopontine angle. The study consolidates the stricter alarm criterion, that is, a criterion prone to trigger early warnings, as found previously by others for vestibular schwannoma surgeries (30% decrease in MEP amplitude).

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