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National survey of emergency physicians for transient ischemic attack (TIA) risk stratification consensus and appropriate treatment for a given level of risk

  • Jeffrey J. Perry (a1) (a2) (a3), Justin H. Losier (a2) (a3), Ian G. Stiell (a1) (a2) (a3), Mukul Sharma (a4) and Kasim Abdulaziz (a1) (a2)...

Abstract

Introduction

Five percent of transient ischemic attack (TIA) patients have a subsequent stroke within 7 days. The Canadian TIA Score uses clinical findings to calculate the subsequent stroke risk within 7 days. Our objectives were to assess 1) anticipated use; 2) component face validity; 3) risk strata for stroke within 7 days; and 4) actions required, for a given risk for subsequent stroke.

Methods

After a rigorous development process, a survey questionnaire was administered to a random sample of 300 emergency physicians selected from those registered in a national medical directory. The surveys were distributed using a modified Dillman technique.

Results

From a total of 271 eligible surveys, we received 131 (48.3%) completed surveys; 96.2% of emergency physicians would use a validated Canadian TIA Score; 8 of 13 components comprising the Canadian TIA Score were rated as Very Important or Important by survey respondents. Risk categories for subsequent stroke were defined as minimal-risk: <1%; low-risk: 1%–4.9%; high-risk 5%–10%; critical-risk: > 10% risk of subsequent stroke within 7 days.

Conclusion

A validated Canadian TIA Score will likely be used by emergency physicians. Most components of the TIA Score have high face validity. Risk strata are definable, which may allow physicians to determine immediate actions, based on subsequent stroke risk, in the emergency department.

Introduction

Cinq pour cent des accidents ischémiques transitoires (AIT) se soldent par la survenue d’un accident vasculaire cérébral (AVC) dans les 7 jours suivants; l’échelle canadienne prévisionnelle du risque d’AVC après un AIT (« Canadian TIA Score »), qui repose sur des caractéristiques cliniques, permet de calculer ce risque d’accident. L’étude visait à évaluer: 1) l’utilisation future de l’instrument; 2) la validité apparente de ses éléments; 3) les catégories de risque d’AVC dans les 7 jours suivants; et 4) les mesures à prendre en fonction du risque d’AVC ultérieur.

Méthode

Après un processus rigoureux d’élaboration, un questionnaire d’enquête a été envoyé à un échantillon aléatoire de 300 médecins d’urgence inscrits dans le répertoire national. Le questionnaire a été distribué selon une version modifiée de la méthode de Dillman.

Résultats

Ont été reçus 131 (48,3 %) questionnaires d’enquête remplis sur un total de 271 jugés recevables. Dans l’ensemble, 96,2 % des médecins d’urgence ont indiqué qu’ils utiliseraient une échelle canadienne validée. Huit caractéristiques sur treize incluses dans l’échelle canadienne étaient considérées comme un élément « Très important » ou « Important » par les répondants au questionnaire. Les catégories de risque d’AVC ultérieur au cours des 7 jours suivants ont été établies comme suit: risque minime: <1 %; risque faible: 1 % – 4,9 %; risque élevé: 5 % – 10 %; risque très élevé: >10 %.

Conclusions

Il est probable que les médecins d’urgence utilisent un instrument canadien validé d’évaluation du risque d’AVC après un AIT. La plupart des caractéristiques incluses dans l’échelle ont une bonne validité apparente. Les classes de risque étant définies, les médecins peuvent prendre des mesures immédiates, en fonction du risque d’AVC ultérieur, au service des urgences.

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Copyright

Corresponding author

Correspondence to: Dr. Jeffrey J. Perry, Clinical Epidemiology Program, F6, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, ON K1Y 4E9; Email: jperry@ohri.ca

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