Jeffrey J Perry1, Mukul Sharma, Marco L A Sivilotti, Jane Sutherland, Andrew Worster, Marcel Émond, Grant Stotts, Albert Y Jin, Wieslaw J Oczkowski, Demetrios J Sahlas, Heather E Murray, Ariane MacKey, Steve Verreault, George A Wells, Ian G Stiell. 1. From the Departments of Emergency Medicine (J.J.P., I.G.S.) and Epidemiology and Community Medicine (G.A.W.) and Division of Neurology (G.S.), University of Ottawa, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (J.J.P., J.S., I.G.S.); Departments of Emergency Medicine (M.L.A.S., H.E.M.) and Biomedical and Molecular Sciences (M.L.A.S.) and Division of Neurology (A.Y.J.), Queen's University, Kingston, Ontario, Canada; Department of Emergency Medicine, Université Laval, Quebec City, Quebec, Canada (M.É.); Divisions of Emergency Medicine (A.W.) and Neurology (M.S., W.J.O, D.J.S.), McMaster University, Hamilton, Ontario, Canada; and Department of Neurology, Hôpital de l'Enfant-Jesus, Quebec City, Quebec, Quebec, Canada (A.M., S.V.).
Abstract
BACKGROUND AND PURPOSE: The occurrence of a transient ischemic attack (TIA) increases an individual's risk for subsequent stroke. The objectives of this study were to determine clinical features of patients with TIA associated with impending (≤7 days) stroke and to develop a clinical prediction score for impending stroke. METHODS: We conducted a prospective cohort study at 8 Canadian emergency departments for 5 years. We enrolled patients with a new TIA. Our outcome was subsequent stroke within 7 days of TIA diagnosis. RESULTS: We prospectively enrolled 3906 patients, of which 86 (2.2%) experienced a stroke within 7 days. Clinical features strongly correlated with having an impending stroke included first-ever TIA, language disturbance, longer duration, weakness, gait disturbance, elevated blood pressure, atrial fibrillation on ECG, infarction on computed tomography, and elevated blood glucose. Variables less associated with having an impending stroke included vertigo, lightheadedness, and visual loss. From this cohort, we derived the Canadian TIA Score which identifies the risk of subsequent stroke≤7 days and consists of 13 variables. This model has good discrimination with a c-statistic of 0.77 (95% confidence interval, 0.73-0.82). CONCLUSIONS: Patients with TIA with their first TIA, language disturbance, duration of symptoms≥10 minutes, gait disturbance, atrial fibrillation, infarction on computed tomography, elevated platelets or glucose, unilateral weakness, history of carotid stenosis, and elevated diastolic blood pressure are at higher risk for an impending stroke. Patients with vertigo and no high-risk features are at low risk. The Canadian TIA Score quantifies the impending stroke risk following TIA.
BACKGROUND AND PURPOSE: The occurrence of a transient ischemic attack (TIA) increases an individual's risk for subsequent stroke. The objectives of this study were to determine clinical features of patients with TIA associated with impending (≤7 days) stroke and to develop a clinical prediction score for impending stroke. METHODS: We conducted a prospective cohort study at 8 Canadian emergency departments for 5 years. We enrolled patients with a new TIA. Our outcome was subsequent stroke within 7 days of TIA diagnosis. RESULTS: We prospectively enrolled 3906 patients, of which 86 (2.2%) experienced a stroke within 7 days. Clinical features strongly correlated with having an impending stroke included first-ever TIA, language disturbance, longer duration, weakness, gait disturbance, elevated blood pressure, atrial fibrillation on ECG, infarction on computed tomography, and elevated blood glucose. Variables less associated with having an impending stroke included vertigo, lightheadedness, and visual loss. From this cohort, we derived the Canadian TIA Score which identifies the risk of subsequent stroke≤7 days and consists of 13 variables. This model has good discrimination with a c-statistic of 0.77 (95% confidence interval, 0.73-0.82). CONCLUSIONS:Patients with TIA with their first TIA, language disturbance, duration of symptoms≥10 minutes, gait disturbance, atrial fibrillation, infarction on computed tomography, elevated platelets or glucose, unilateral weakness, history of carotid stenosis, and elevated diastolic blood pressure are at higher risk for an impending stroke. Patients with vertigo and no high-risk features are at low risk. The Canadian TIA Score quantifies the impending stroke risk following TIA.
Authors: Jeffrey J Perry; Marco L A Sivilotti; Marcel Émond; Ian G Stiell; Grant Stotts; Jacques Lee; Andrew Worster; Judy Morris; Ka Wai Cheung; Albert Y Jin; Wieslaw J Oczkowski; Demetrios J Sahlas; Heather E Murray; Ariane Mackey; Steve Verreault; Marie-Christine Camden; Samuel Yip; Philip Teal; David J Gladstone; Mark I Boulos; Nicolas Chagnon; Elizabeth Shouldice; Clare Atzema; Tarik Slaoui; Jeanne Teitlebaum; Kasim Abdulaziz; Marie-Joe Nemnom; George A Wells; Mukul Sharma Journal: BMJ Date: 2021-02-04
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Authors: Dawn M Bravata; Laura J Myers; Mathew Reeves; Eric M Cheng; Fitsum Baye; Susan Ofner; Edward J Miech; Teresa Damush; Jason J Sico; Alan Zillich; Michael Phipps; Linda S Williams; Seemant Chaturvedi; Jason Johanning; Zhangsheng Yu; Anthony J Perkins; Ying Zhang; Greg Arling Journal: JAMA Netw Open Date: 2019-07-03
Authors: Andrew M Penn; Nicole S Croteau; Kristine Votova; Colin Sedgwick; Robert F Balshaw; Shelagh B Coutts; Melanie Penn; Kaitlin Blackwood; Maximilian B Bibok; Viera Saly; Janka Hegedus; Amy Y X Yu; Charlotte Zerna; Evgenia Klourfeld; Mary L Lesperance Journal: BMC Neurol Date: 2019-10-25 Impact factor: 2.474