title: Patients referred for TIA may still have persisting neurological deficits.
abstract: BACKGROUND
  The presence of residual neurological deficits after neurological symptoms is important information for making a diagnosis of Transient Ischemic Attack (TIA) versus stroke. The purpose of this study was to establish the reliability of the referring physician (non neurologist) to report focal neurological deficits in the context of an urgent referral for TIA.
  
  
  METHODS
  Prospectively recorded urgent physician-to-physician phone referrals for TIA through the Southern Alberta TIA hotline from March 2009 to July 2010 were reviewed. "Has the neurological deficit completely resolved?" was asked to the referring physician (family or emergency room physician) and recorded prospectively as a yes/no response. Patients were included if a neurological examination was performed by a neurologist on the same day as referral. The neurologist's assessment of whether the deficit had resolved was compared to that of the referring physician.
  
  
  RESULTS
  78 patients were included in this study. 62 patients had resolved as per the referring physician's assessment. Of these 62 patients, 16 (25.8% 95%CI 16-38) had evidence of persisting neurological deficits on the neurologist's assessment. A wide variety of mild neurological deficits were identified. None of these deficits appeared to be explained by progression of symptoms.
  
  
  CONCLUSIONS
  Physicians referring patients with TIA syndromes for emergent assessment do not reliably detect mild residual deficits in one-quarter of patients. We are questioning the validity of neurological deficit resolution as a triage rule. The findings suggest that studies of TIA likely include a proportion of minor stroke patients and this should be remembered when extrapolating the results to other populations.
authors.affiliation: Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.
authors.forename: Francois
authors.initials: F
authors.lastname: Moreau
authors.forename: Thomas
authors.initials: T
authors.lastname: Jeerakathil
authors.forename: Shelagh B
authors.initials: SB
authors.lastname: Coutts
authors.lastname: FRCPC for the ASPIRE investigators
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011446:Prospective Studies; D012017:Referral and Consultation; D015203:Reproducibility of Results; D013997:Time Factors