Predictive values of referrals for transient ischaemic attack from first-contact health care: a systematic review

Kandiyali, Rebecca; Lasserson, Daniel; Whiting, Penny; Richards, Alison; Mant, Jonathan

doi:10.3399/bjgp17x693677

Cited by 8 publications

(6 citation statements)

References 31 publications

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“…Additionally, when excluding hospitalizations with stroke‐related procedures from recurrent stroke cases, the PPV for recurrent stroke increased to 78%; this increase was not statistically significant. While the PPV of 78% is a lower range of previously reported PPVs for incident stroke, it is higher than reported PPVs (12.9%–72.5%) for transient ischemic attack 14 …”

Section: Discussioncontrasting

confidence: 78%

“…While the PPV of 78% is a lower range of previously reported PPVs for incident stroke, it is higher than reported PPVs (12.9%-72.5%) for transient ischemic attack. 14 Though the PPV of ICD-10 codes for ischemic incident stroke has been examined, 6 to date, no studies have examined the PPV of ICD-10 codes for recurrent ischemic stroke. This study has some limitations.…”

Section: Discussionmentioning

confidence: 99%

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Validation of ICD‐10 hospital discharge diagnosis codes to identify incident and recurrent ischemic stroke from a US integrated healthcare system

Shirley,

Morrisette,

Choi

et al. 2023

Pharmacoepidemiology and Drug

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PurposeThis study validated incident and recurrent ischemic stroke identified by International Classification of Diseases, Tenth Revision, Clinical Modification (ICD‐10) hospital discharge diagnosis codes.MethodsUsing electronic health records (EHR) of adults (≥18 years) receiving care from Kaiser Permanente Southern California with ICD‐10 hospital discharge diagnosis codes of ischemic stroke (I63.x, G46.3, and G46.4) between October 2015 and September 2020, we identified 75 patients with both incident and recurrent stroke events (total 150 cases). Two neurologists independently evaluated validity of ICD‐10 codes through chart reviews.ResultsThe positive predictive value (PPV, 95% CI) for incident stroke was 93% (95% CI: 88%, 99%) and the PPV for recurrent stroke was 72% (95% CI: 62%, 82%). The PPV for recurrent stroke improved after applying a gap of 20 days (PPV of 75%; 95% CI: 63%, 87%) or removing hospital admissions related to stroke‐related procedures (PPV of 78%; 95% CI: 68%, 88%).ConclusionThe ICD‐10 hospital discharge diagnosis codes for ischemic stroke showed a high PPV for incident cases, while the PPV for recurrent cases were less optimal. Algorithms to improve the accuracy of ICD‐10 codes for recurrent ischemic stroke may be necessary.

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Section: Discussioncontrasting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Validation of ICD‐10 hospital discharge diagnosis codes to identify incident and recurrent ischemic stroke from a US integrated healthcare system

Shirley,

Morrisette,

Choi

et al. 2023

Pharmacoepidemiology and Drug

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“…Despite differences between previous studies, it may be assumed that overall PPV for initially suspected stroke approaches 75% [3,7], and ranges from 13% to 73% for TIA [16]. However, if the patient is being referred from a nursing home, the PPV for stroke may be more than two-fold lower [17] In previous studies, ambulance physicians were reported to detect stroke with PPV of 67% to 83% [18].…”

Section: Discussionmentioning

confidence: 95%

Reliability of prehospital diagnosis of acute cerebrovascular accident

Karliñski

Kozera-Strzelińska

Sienkiewicz-Jarosz

et al. 2022

Neurol Neurochir Pol.

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Introduction.Early and correct suspicion of an acute cerebrovascular accident (CVA) is necessary to minimise the time to reperfusion treatment. Our aim was to evaluate the reliability of a prehospital diagnosis of stroke or transient ischaemic attack made by healthcare professionals referring patients directly to a neurological Emergency Department (ED).Material and methods. This retrospective analysis included all consecutive patients referred between 1 January and 31 December 2014 by ambulance physicians, paramedics or outpatient physicians to the neurological ED providing care for the 300-350,000 inhabitants of a highly urbanised area. We calculated sensitivity and positive predictive value (PPV) with 95% confidence intervals (95% CI) for each group of healthcare professionals, and compared the proportions of undetected CVAs. Results.Of 802 patients referred with a prehospital diagnosis of CVA, 544 were confirmed. Additional 95 CVA cases were referred with a diagnosis other than CVA. The highest sensitivity for detection of any CVA was among ambulance physicians (96%; 95% CI 92-98%), followed by paramedics (85%; 95% CI 80-90%; p < 0.001) and outpatient physicians (74%; 95% CI 70-79%; p < 0.001). PPV for stroke was 83% (95% CI 77-87%) among ambulance physicians, 73% (95% CI 65-80%) among paramedics, and 56% (95% CI 47-64%) among outpatient physicians.Conclusions. Ambulance physicians are highly sensitive in diagnosing any CVA, and are correct in 8 out of 10 cases. The inferior performance of paramedics and outpatient physicians indicates the need for regular stroke training for paramedics and the implementation of two-way communication with the stroke team to identify potential candidates for reperfusion therapy before arrival at the ED.

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“…With increasing incidence of neurological diseases, it is more likely for all doctors, especially general practitioners and internal medicine physicians, to manage neurological patients. The clinical competency of initiating primary assessment and management of neurological diseases is essential for every graduating medical student (Kandiyali et al, 2017;Bradley, 2000). The difficulty in neurology learning elicits a negative impact to medical students on both the clinical competency of dealing with neurology patients and their career choice of becoming neurologists (Pakpoor et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

What is the best option to manage the bedside teaching for Neurology Clerkship -- Demonstration, Simulation or WeChat teaching?

Zhou¹,

Feng²,

Lu³

et al. 2020

MedEdPublish

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Background: Neurological clerkship is an important but challenging part of the neurology curriculum, and bedside teaching is essential for clerks to integrate complex theories and skills into practice.Objective: This study aimed to investigate the three bedside teaching methods as modified bedside demonstration, simulation via standard patients as well as WeChat-assisted teaching during neurological clerkship, in order to identify the optimal method. Design: The 4 th -year medical students were enrolled during their neurological clerkship. Bedside teaching on topics of acute ischemic stroke, acute myelitis and myasthenia gravis were delivered in a random order of demonstration, simulation and WeChat-assisted teaching. A questionnaire was assigned to each participant at the end of the twoweek clerkship to rank the three methods based on their general impression, as well as detailed assessment of clinical abilities and attitudes.Results: A total of 112 clerks were enrolled and 98 were eligible for analysis. For both general and overall ranking, simulation was the most approved bedside teaching method while WeChat-assisted teaching took the least approval among the three. A majority of participants preferred simulation because of the significant improvement on interpretation of diseases, interest in neurology, diagnostic skills, clinical skills, communication skills, empathy and protection of privacy (P 0.05). Demonstration was considered to benefit performance in examination (P=0.009). The ranking of the three methods revealed different consistency between general impression and detailed assessment. More participants tended to underestimate themselves in simulation but to overestimate themselves in

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Predictive values of referrals for transient ischaemic attack from first-contact health care: a systematic review

Cited by 8 publications

References 31 publications

Validation of ICD‐10 hospital discharge diagnosis codes to identify incident and recurrent ischemic stroke from a US integrated healthcare system

Validation of ICD‐10 hospital discharge diagnosis codes to identify incident and recurrent ischemic stroke from a US integrated healthcare system

Reliability of prehospital diagnosis of acute cerebrovascular accident

What is the best option to manage the bedside teaching for Neurology Clerkship -- Demonstration, Simulation or WeChat teaching?

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