Background and Purpose:
The
diagnosis of transient ischemic attack (TIA) is largely dependent on a
process of clinical decision-making that remains poorly characterized in
the absence of a validated and accessible biomarker or imaging test. We
performed a retrospective chart review to identify variables associated
with a final neurologist diagnosis of TIA/stroke.
Methods:
Records
for all patients seen in The Ottawa Hospital’s Stroke Prevention Clinic
in 2015 were analyzed for patient and referral characteristics,
features of the presenting neurological event, and final diagnosis by a
stroke neurologist (classified as definite, possible, or definite not
TIA/stroke). Multinomial logistic regression analysis with backward
elimination was used to identify variables associated with the final
diagnosis.
Results:
Our
inclusion criteria were met by 1894 patients. After backward
elimination, 23 potentially important variables were identified,
including monocular vision loss (odds ratio [OR]: 30.4, 95% confidence
interval [CI]: 14.6-63.3), symptoms of sudden onset (OR: 28.3, 95% CI:
14.2-56.2), unilateral weakness affecting 2 or 3 of face, arm, or leg
(OR: 17.7, 95% CI: 9.8-31.7), and homonymous hemianopia (OR: 16.6, 95%
CI: 8.1-34.0).
Conclusions:
Accurate
diagnosis of TIA is essential to initiating appropriate secondary
stroke prevention therapies. A focus on elements of the patient history
most commonly associated with a final diagnosis of TIA/stroke may help
to identify patients in greatest need of urgent SPC assessment and allow
for the provision of effective and efficient stroke prevention
services.
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