Carlo W Cereda1, Paul M George2, Manabu Inoue2, Nirali Vora2, Jean-Marc Olivot3, Neil Schwartz2, Maarten G Lansberg2, Stephanie Kemp2, Michael Mlynash2, Gregory W Albers2. 1. Department of Neurology & Neurologic Sciences, Stanford Stroke Center, Stanford University, Stanford, USA Stroke Center, Neurocentre (EOC) of Southern Switzerland, Lugano, Switzerland carlo.cereda@eoc.ch. 2. Department of Neurology & Neurologic Sciences, Stanford Stroke Center, Stanford University, Stanford, USA. 3. Department of Neurology, Stroke Center, Hôpital Pierre-Paul Riquet, Toulouse, France.
Abstract
BACKGROUND: No definitive criteria are available to confirm the diagnosis of transient ischemic attack. Inter-rater agreement between physicians regarding the diagnosis of transient ischemic attack is low, even among vascular neurologists. We developed the Precise Diagnostic Score, a diagnostic score that consists of discrete and well-defined clinical and imaging parameters, and investigated inter-rater agreement in patients with suspected transient ischemic attack. METHODS: Fellowship-trained vascular neurologists, blinded to final diagnosis, independently reviewed retrospectively identical history, physical examination, routine diagnostic studies, and brain magnetic resonance imaging (diffusion and perfusion images) from consecutive patients with suspected transient ischemic attack. Each patient was rated using the 8-point Precise Diagnostic Score score, composed of a clinical score (0-4 points) and an imaging score (0-4 points). The composite Precise Diagnostic Score determines a Precise Diagnostic Score Likelihood of Brain Ischemia Scale: 0-1 = unlikely, 2 = possible, 3 = probable, 4-8 = very likely. RESULTS: Three raters reviewed data from 114 patients. Using Precise Diagnostic Score, all three raters scored a similar percentage of the clinical events as being "probable" or "very likely" caused by brain ischemia: 57, 55, and 58%. Agreement was high for both total Precise Diagnostic Score (intraclass correlation coefficient of 0.94) and for the Likelihood of Brain Ischemia Scale (agreement coefficient of 0.84). CONCLUSIONS: Compared with prior studies, inter-rater agreement for the diagnosis of transient brain ischemia appears substantially improved with the Precise Diagnostic Score scoring system. This score is the first to include specific criteria to assess the clinical relevance of diffusion-weighted imaging and perfusion lesions and supports the added value of magnetic resonance imaging for assessing patients with suspected transient ischemic attack.
BACKGROUND: No definitive criteria are available to confirm the diagnosis of transient ischemic attack. Inter-rater agreement between physicians regarding the diagnosis of transient ischemic attack is low, even among vascular neurologists. We developed the Precise Diagnostic Score, a diagnostic score that consists of discrete and well-defined clinical and imaging parameters, and investigated inter-rater agreement in patients with suspected transient ischemic attack. METHODS: Fellowship-trained vascular neurologists, blinded to final diagnosis, independently reviewed retrospectively identical history, physical examination, routine diagnostic studies, and brain magnetic resonance imaging (diffusion and perfusion images) from consecutive patients with suspected transient ischemic attack. Each patient was rated using the 8-point Precise Diagnostic Score score, composed of a clinical score (0-4 points) and an imaging score (0-4 points). The composite Precise Diagnostic Score determines a Precise Diagnostic Score Likelihood of Brain Ischemia Scale: 0-1 = unlikely, 2 = possible, 3 = probable, 4-8 = very likely. RESULTS: Three raters reviewed data from 114 patients. Using Precise Diagnostic Score, all three raters scored a similar percentage of the clinical events as being "probable" or "very likely" caused by brain ischemia: 57, 55, and 58%. Agreement was high for both total Precise Diagnostic Score (intraclass correlation coefficient of 0.94) and for the Likelihood of Brain Ischemia Scale (agreement coefficient of 0.84). CONCLUSIONS: Compared with prior studies, inter-rater agreement for the diagnosis of transient brain ischemia appears substantially improved with the Precise Diagnostic Score scoring system. This score is the first to include specific criteria to assess the clinical relevance of diffusion-weighted imaging and perfusion lesions and supports the added value of magnetic resonance imaging for assessing patients with suspected transient ischemic attack.
Authors: Muhammad Nagy; Muhammad U Azeem; Youssef Soliman; Sahil A Nawab; Adalia H Jun-O'Connell; Richard P Goddeau; Majaz Moonis; Brian Silver; Nils Henninger Journal: J Stroke Cerebrovasc Dis Date: 2019-01-07 Impact factor: 2.136
Authors: E Prodi; L Danieli; C Manno; A Pagnamenta; E Pravatà; L Roccatagliata; C Städler; C W Cereda; A Cianfoni Journal: AJNR Am J Neuroradiol Date: 2021-12-30 Impact factor: 3.825
Authors: L Servaas Dolmans; Elena R Lebedeva; Dinusha Veluponnar; Ewoud J van Dijk; Paul J Nederkoorn; Arno W Hoes; Frans H Rutten; Jes Olesen; L Jaap Kappelle Journal: Stroke Date: 2019-06-20 Impact factor: 7.914