Agreement Regarding Diagnosis of Transient Ischemic Attack Fairly Low Among Stroke-Trained Neurologists

被引:144
作者
Castle, James [3 ]
Mlynash, Michael [1 ,2 ]
Lee, Karming [4 ]
Caulfield, Anna Finley [1 ,2 ]
Wolford, Connie [1 ,2 ]
Kemp, Stephanie [1 ,2 ]
Hamilton, Scott [1 ,2 ]
Albers, Gregory W. [1 ,2 ]
Olivot, Jean-Marc [1 ,2 ]
机构
[1] Stanford Univ, Med Ctr, Dept Neurol & Neurol Sci, Palo Alto, CA 94304 USA
[2] Stanford Univ, Med Ctr, Stanford Stroke Ctr, Palo Alto, CA 94304 USA
[3] N Shore Univ HealthSyst, Pritzker Sch Med, Dept Neurol, Evanston, IL USA
[4] Univ Toronto, Dept Psychiat, Toronto, ON, Canada
关键词
diagnosis; TIA; interrater agreement; INTEROBSERVER AGREEMENT; VALIDATION;
D O I
10.1161/STROKEAHA.109.577650
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and Purpose-Agreement between physicians to define the likelihood of a transient ischemic attack (TIA) remains poor. Several studies have compared neurologists with nonneurologists, and neurologists among themselves, but not between fellowship-trained stroke neurologists. We investigated the diagnostic agreement in 55 patients with suspected TIA. Methods-The history and physical examination findings of 55 patients referred to the Stanford TIA clinic from the Stanford emergency room were blindly reviewed by 3 fellowship-trained stroke neurologists who had no knowledge of any test results or patient outcomes. Each patient's presentation was rated as to the likelihood that the presentation was consistent with TIA. We used 3 different scales (2-, 3-, and 4-point scales) to define TIA likelihood. We assessed global agreement between the raters and evaluated the biases related to individual raters and scale type. Results-The agreement between fellowship-trained stroke neurologists remained poor regardless of the rating system used and the statistical test used to measure it. Difference in rating bias among all raters was significant for each scale: P=0.001, 0.012, and <0.001. In addition, for each reviewer, the rate of labeling an event an "unlikely TIA" progressively decreased with the number of points that composed the scale. Conclusions-TIA remains a highly subjective diagnosis, even among stroke subspecialists. The use of confirmatory testing beyond clinical judgment is needed to help solidify the diagnosis. Caution should be used when diagnosing an event as a possible TIA. (Stroke. 2010;41:1367-1370.)
引用
收藏
页码:1367 / 1370
页数:4
相关论文
共 13 条
[1]   Definition and Evaluation of Transient Ischemic Attack A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. [J].
Easton, J. Donald ;
Saver, Jeffrey L. ;
Albers, Gregory W. ;
Alberts, Mark J. ;
Chaturvedi, Seemant ;
Feldmann, Edward ;
Hatsukami, Thomas S. ;
Higashida, Randall T. ;
Johnston, S. Claiborne ;
Kidwell, Chelsea S. ;
Lutsep, Helmi L. ;
Miller, Elaine ;
Sacco, Ralph L. .
STROKE, 2009, 40 (06) :2276-2293
[2]   Diagnosis of transient ischemic attack by the nonneurologist - A validation study [J].
Ferro, JM ;
Falcao, I ;
Rodrigues, G ;
Canhao, P ;
Melo, TP ;
Oliveira, V ;
Pinto, AN ;
Crespo, M ;
Salgado, AV .
STROKE, 1996, 27 (12) :2225-2229
[3]   Risk of stroke early after transient ischaemic attack: a systematic review and meta-analysis [J].
Giles, Matthew F. ;
Rothwell, Peter M. .
LANCET NEUROLOGY, 2007, 6 (12) :1063-1072
[4]  
Gwet K., 2001, HDB INTERRATER RELIA
[5]   Prevalence and knowledge of transient ischemic attack among US adults [J].
Johnston, SC ;
Fayad, PB ;
Gorelick, PB ;
Hanley, DF ;
Shwayder, P ;
van Husen, D ;
Weiskopf, T .
NEUROLOGY, 2003, 60 (09) :1429-1434
[6]   Transient ischemic attack [J].
Johnston, SC .
NEW ENGLAND JOURNAL OF MEDICINE, 2002, 347 (21) :1687-1692
[7]   Factors associated with the decision to hospitalize patients after transient ischemic attack before publication of prediction rules [J].
Josephson, S. Andrew ;
Sidney, Stephen ;
Pham, Trinh N. ;
Bernstein, Allan L. ;
Johnston, S. Claiborne .
STROKE, 2008, 39 (02) :411-413
[8]   Validation of the ACAS TIA/stroke algorithm [J].
Karanjia, PN ;
Nelson, JJ ;
Lefkowitz, DS ;
Dick, AR ;
Toole, JF ;
Chambless, LE ;
Hayes, R ;
Howard, VJ .
NEUROLOGY, 1997, 48 (02) :346-351
[9]   DIAGNOSIS OF TRANSIENT ISCHEMIC ATTACKS - IMPROVEMENT OF INTEROBSERVER AGREEMENT BY A CHECKLIST IN ORDINARY LANGUAGE [J].
KOUDSTAAL, PJ ;
VANGIJN, J ;
STAAL, A ;
DUIVENVOORDEN, HJ ;
GERRITSMA, JGM ;
KRAAIJEVELD, CL .
STROKE, 1986, 17 (04) :723-728
[10]   INTEROBSERVER AGREEMENT FOR THE DIAGNOSIS OF TRANSIENT ISCHEMIC ATTACKS [J].
KRAAIJEVELD, CL ;
VANGIJN, J ;
SCHOUTEN, HJA ;
STAAL, A .
STROKE, 1984, 15 (04) :723-725