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

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 minimalrisk: <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.

Prospective validation of Canadian TIA Score and comparison with ABCD2 and ABCD2i for subsequent stroke risk after transient ischaemic attack: multicentre prospective cohort study

“…We had previously surveyed both neurologists and emergency physicians to identify thresholds of stroke risk that would alter clinical decisions 2627. In these studies, respondents indicated that patients with a subsequent risk of stroke below 1% were most appropriate for outpatient investigation, whereas patients with a subsequent risk of stroke above 5% constitute a high risk group that might benefit from comprehensive investigation, more intensive therapy, and possible admission at the time of the initial emergency department visit.…”

“…The interval likelihood ratio is the multilevel extension of the positive and negative likelihood ratios, which are applicable only when a test/risk score is dichotomised into two levels (positive versus negative or high risk versus low risk). We pre-specified risk thresholds (low risk <1%, medium risk 1-5%, and high risk >5%) on the basis of previous surveys of emergency physicians and neurologists to group discrete risk scores into these three risk levels 2627. We calculated the sensitivity and specificity when the score was dichotomised at each integer value from −3 to 23.…”

Perception of post-stroke patients on case management conducted by nurses

“…Another benefit perceived by the research participants was the positive impact of the case management developed by the nurse throughout the recovery process, through individualized and interdisciplinary actions. Changing life habits requires an action plan that is developed according to the individual's level of understanding, which reduces their resistance to treatment and increases the possibility of setting strategies and goals to change habits according to the necessity, adapting when and how it is necessary (4,9) . Among the benefits recognized by the participants regarding case management, there is the bond created between the post-stroke patient and the case manager nurse, evidenced by the statements that express trust between them.…”

“…In Brazil, strokes are the main cause of hospitalizations, mortality, and disabilities, overcoming several other heart diseases and even cancer. This situation results in a considerable socioeconomic impact (3)(4) .…”

Attitudes and acceptability of organ and tissue donation registration in the emergency department: a national survey of emergency physicians

“…This resulted in 196 subjects. Based on an expected response rate of 40–50% from previous studies that surveyed the same population [ 15 , 16 ], we chose to survey 500 physicians. Half of the participants were randomly selected to receive a prenotification letter approximately one week prior to the survey outlining that they had been selected to receive a survey to emphasize the importance of their input.…”