Background: In 2010, the Swedish Stroke Register (Riksstroke; RS) established a module for transient ischemic attacks (RS-TIA). We report a diagnostic validation study of patients included in RS-TIA. Methods: During the first year, 7,825 patients were registered at 59 out of 74 Swedish hospitals. A time-based TIA definition was applied. A sample of 180 patients (30 patients each from 6 hospitals), with a similar distribution of age and sex as in RS-TIA, was prepared. Two independent observers assessed medical records for quality of documentation and assigned a diagnosis of likely, possible, unlikely TIA or ischemic stroke, according to prespecified criteria. Results: The 2 observers agreed in 77% of cases that the event was a likely or possible TIA, in 3% that the event was an ischemic stroke, and in 2% that the event was an unlikely TIA. The observers disagreed in 8% of patients on TIA vs. ischemic stroke, and in 11% on a vascular vs. non-vascular cause. Quality of documentation was fair. Conclusions: There was interobserver agreement on diagnosis of TIA in the majority of patients included in RS-TIA. Diagnostic accuracy may be further improved by more systematic documentation of symptoms and signs.

Keywords:
TIA, Diagnosis, Validation, Register
1.
Rothwell PM, Giles MF, Chandratheva A, Marquardt L, Geraghty O, Redgrave JN, et al; Early use of Existing Preventive Strategies for Stroke (EXPRESS) Study: Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison. Lancet 2007;370:1432-1442.
2.
Lavallée PC, Meseguer E, Abboud H, Cabrejo L, Olivot JM, Simon O, et al: A transient ischaemic attack clinic with round-the-clock access (SOS-TIA): feasibility and effects. Lancet Neurol 2007;6:953-960.
3.
Cameron AC, Dawson J, Quinn TJ, Walters MR, McInnes GT, Morrison D, et al: Long-term outcome following attendance at a transient ischemic attack clinic. Int J Stroke 2011;6:306-311.
4.
The ad hoc Committee on the classification and outline of cerebrovascular diseases II. Stroke 1975;6:566-616.
5.
Castle J, Mlynash M, Lee K, Caulfield AF, Wolford C, Kemp S, et al: Agreement regarding diagnosis of transient ischemic attack fairly low among stroke-trained neurologists. Stroke 2010;41:1367-1370.
6.
Ives DG, Fitzpatrick AL, Bild DE, Psaty BM, Kuller LH, Crowley PM, et al: Surveillance and ascertainment of cardiovascular events. The cardiovascular health study. Ann Epidemiol 1995;5:278-285.
7.
Holick CN, Turnbull BR, Jones ME, Chaudhry S, Bangs ME, Seeger JD: Atomoxetine and cerebrovascular outcomes in adults. J Clin Psychopharmacol 2009;29:453-460.
8.
Ghia D, Thomas PR, Cordato DJ, Worthington JM, Cappelen-Smith C, Griffith N, et al: Validation of emergency and final diagnosis coding in transient ischemic attack: South Western Sydney transient ischemic attack study. Neuroepidemiology 2010;35:53-58.
9.
Kokotailo RA, Hill MD: Coding of stroke and stroke risk factors using international classification of diseases, revisions 9 and 10. Stroke 2005;36:1776-1781.
10.
Krarup LH, Boysen G, Janjua H, Prescott E, Truelsen T: Validity of stroke diagnoses in a national register of patients. Neuroepidemiology 2007;28:150-154.
11.
Paul NL, Simoni M, Rothwell PM; Oxford Vascular Study: Transient isolated brainstem symptoms preceding posterior circulation stroke: a population-based study. Lancet Neurol 2013;12:65-71.
12.
Lavallée PC, Cabrejo L, Labreuche J, Mazighi M, Meseguer E, Guidoux C, et al: Spectrum of transient visual symptoms in a transient ischemic attack cohort. Stroke 2013;44:3312-3317.
© 2015 S. Karger AG, Basel
2015
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.