National survey of Canadian neurologists' current practice for transient ischemic attack and the need for a clinical decision rule.
OBJECTIVE
Four percent to 10% of patients with transient ischemic attack (TIA) have a stroke or die within 1 week of their diagnosis. This national survey examined Canadian neurologists' current practice for managing TIA, the need for a clinical decision rule to identify high-risk patients, and the required sensitivity of such a rule.


METHODS
We surveyed 650 neurologists registered in a national physician directory. We used a modified Dillman technique with a prenotification letter and up to 5 survey attempts using a mailed letter. Neurologists were asked 33 questions about demographics, current management of adult patients with TIA, if a clinical decision rule is required to identify high-risk patients with TIA for impending stroke/death, and the required sensitivity of this rule.


RESULTS
We had a response rate of 49.8% (324 of 650). Respondents were 78.3% male and had a mean age of 50.3 years. Of respondents, 49.2% (95% CI: 45.3% to 53.1%) reported using an existing clinical tool to risk-stratify patients. Overall, 95.0% (95% CI: 93.3% to 96.7%) reported they would consider using a sensitive, validated clinical decision rule for risk-stratifying patients with TIA. The median required sensitivity of a rule was 92% (interquartile range, 90 to 95).


CONCLUSIONS
We found that Canadian neurologists would use a highly sensitive clinical decision rule to risk-stratify patients with TIA. The median required sensitivity of 92% is higher than the high risk category of any existing tool. Our results indicate a clinical decision rule to predict high-risk TIA needs to be more sensitive than the currently available rules.
Department of Emergency Medicine, Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada. jperry@ohri.ca
Jeffrey J
JJ
Perry
Marlène
M
Mansour
Michael
M
Sharma
Cheryl
C
Symington
Jamie
J
Brehaut
Monica
M
Taljaard
Ian G
IG
Stiell
D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D003625:Data Collection; D019468:Disease Management; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009462:Neurology / Q000379:methods*; D010820:Physicians; D012307:Risk Factors