scholarly journals Letter by Dutta Regarding Article, “Diagnostic Accuracy of the Explicit Diagnostic Criteria for Transient Ischemic Attack: A Validation Study”

Stroke ◽  
2019 ◽  
Vol 50 (11) ◽  
Author(s):  
Dipankar Dutta
Keyword(s):  
Diagnostic Accuracy ◽  
Diagnostic Criteria ◽  
Validation Study ◽  
Transient Ischemic Attack ◽  
Ischemic Attack

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 Diagnostic Accuracy of Transient Ischemic Attack from Physician Claims

2017 ◽  
Vol 44 (4) ◽  
pp. 397-403
Author(s):  
Jodi D. Edwards ◽  
Mieke Koehoorn ◽  
Lara A. Boyd ◽  
Boris Sobolev ◽  
Adrian R. Levy
Keyword(s):  
Diagnostic Accuracy ◽  
Transient Ischemic Attack ◽  
Hospital Admissions ◽  
Population Based ◽  
Discharge Data ◽  
Predictive Values ◽  
Physician Visits ◽  
Physician Billing ◽  
Ischemic Attack ◽  
The Impact

AbstractBackground:Hospitalization data underestimate the occurrence of transient ischemic attack (TIA). As TIA is frequently diagnosed in primary care, methodologies for the accurate ascertainment of a TIA from physician claims data are required for surveillance and health systems planning in this population. The present study evaluated the diagnostic accuracy of multiple algorithms for TIA from a longitudinal population-based physician billing database.Methods:Population-based administrative data from the province of British Columbia were used to identify the base population (1992–2007;N=102,492). Using discharge records for hospital admissions for acute ischemic stroke with a recent (<90 days) TIA as the reference standard, we performed receiver-operating characteristic analyses to calculate sensitivity, specificity, positive and negative predictive values and overall accuracy, and to compare area under the curve for each physician billing algorithm. To evaluate the impact of different case definitions on population-based TIA burden, we also estimated the annual TIA occurrence associated with each algorithm.Results:Physician billing algorithms showed low to moderate sensitivity, with the algorithm for two consecutive physician visits within 90 days showing the highest sensitivity at 37.7% (CI95%=37.4–38.1). All algorithms demonstrated high specificity and moderate to high overall accuracy, resulting in low positive predictive values (≤5%), low discriminability (0.53–0.57) and high false positive rates (1 – specificity). Population-based estimates of TIA occurrence were comparable to prior studies and declined over time.Conclusions:Physician billing data have insufficient sensitivity to identify TIAs but may be used in combination with hospital discharge data to improve the accuracy of estimating the population-based occurrence of TIAs.

scholarly journals Candidate Biomarkers for the Diagnosis of Transient Ischemic Attack: A Systematic Review

2019 ◽  
Vol 47 (5-6) ◽  
pp. 207-216 ◽  
Author(s):  
L. Servaas Dolmans ◽  
Frans H. Rutten ◽  
Niels C.T. Koenen ◽  
Marie-Louise E.L. Bartelink ◽  
Johannes B. Reitsma ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Diagnostic Accuracy ◽  
Brain Ischemia ◽  
Transient Ischemic Attack ◽  
Current Evidence ◽  
Sufficient Information ◽  
Stroke Patients ◽  
Fatty Acid Binding ◽  
Ischemic Attack

Background and Purpose: A rapid serum biomarker that confirms or rules out a transient ischemic attack (TIA) would be of great value in clinical practice. We aimed to systematically review current evidence for the diagnostic accuracy of blood biomarkers in the early diagnosis of TIA. Methods: This is a systematic review with quality appraisal of individual studies using the QUADAS-2 tool. MEDLINE and EMBASE databases were searched up to May 1, 2017, to select primary diagnostic accuracy studies evaluating potential biomarkers in blood for the diagnosis of TIA or ischemic stroke. Results: Of 4,215 studies retrieved, 78 met our eligibility criteria. Forty-five studies restricted their population to ischemic stroke patients, 32 included both TIA and ischemic stroke patients, and only one study was restricted to TIA patients. In total 62/78 (79.5%) studies had a case-control design comparing TIA or stroke patients with healthy subjects. Overall, 125 single biomarkers and 5 biomarker panels were studied, with a median number of participants per study of 92.0 (interquartile range 44.8–144.5), varying from 8 to 915. Sufficient information to extract 2 × 2 tables was available for 35 (44.9%) articles, and for 60 (48.0 %) biomarkers. Several markers, such as NR2A/B (antibodies), Parkinson 7, nucleoside diphosphate kinase A, ubiquitin fusion degradation protein-1, and heart-type fatty acid binding protein, have shown moderate to high diagnostic accuracy in multiple studies. Conclusions: Although the methodological quality of studies evaluating biomarkers of brain ischemia was poor, several biomarkers have shown the potential to detect transient brain ischemia in an early phase. Diagnostic accuracy studies in suspected cases of TIA are needed to determine their true clinical value.

scholarly journals Diagnostic criteria for transient ischemic attack

2018 ◽  
Vol 10 (2) ◽  
pp. 12-19
Author(s):  
E. R. Lebedeva ◽  
N. M. Gurary ◽  
J. Olesen
Keyword(s):  
Diagnostic Criteria ◽  
Transient Ischemic Attack ◽  
Ischemic Attack

Transient Ischemic Attack (TIA): A Problem Not to Miss

2017 ◽  
Vol 48 (S 01) ◽  
pp. S1-S45
Author(s):  
N. Plesko-Altermatt ◽  
S. Grunt ◽  
M. Diepold ◽  
E. Perret-Hoigné ◽  
T. Horvath ◽  
...  
Keyword(s):  
Transient Ischemic Attack ◽  
Ischemic Attack
Sign in / Sign up

Export Citation Format

Share Document