title: A cross-sectional study of individuals seeking information on transient ischemic attack and stroke symptoms online: a target for intervention?
abstract: BACKGROUND
  Individuals with TIA/stroke symptoms often do not seek urgent medical attention. We assessed the feasibility of identifying individuals searching for information on TIA/stroke symptoms online as a target for future interventions to encourage urgent evaluation and we evaluated the performance of a self-reported risk score to identify subjects with true TIA or stroke.
  
  
  RESULTS
  We placed online advertisements to target English-speaking adults in the United States searching for TIA/stroke-related keywords. After completing an online questionnaire, participants were telephoned by a vascular neurologist to assess the likelihood of TIA/stroke. We used logistic regression and the c-statistic to assess associations and model discrimination respectively. Over 122 days, 251 (1%) of 25,292 website visitors completed the online questionnaire and 175 were reached by telephone (mean age 58.5 years; 63% women) for follow-up. Of these participants, 37 (21%) had symptoms within 24 hours, 60 (34%) had not had a medical evaluation yet, and 68 (39%) had TIA/stroke. Applying a modified ABCD(2) score yielded a c-statistic of 0.66, but 2 of 12 with a zero score had a TIA/stroke. Those with new symptoms were more likely to have TIA/stroke (OR 4.90, 95% CI 2.56-9.09).
  
  
  CONCLUSIONS
  Individuals with TIA/stroke that are seeking real-time information on symptoms online can be readily identified, in some cases before they have sought formal medical evaluation. Although a simple self-reported risk score was unable to identify a low-risk population in this selected group, this population may still present an attractive target for future interventions designed to encourage urgent medical evaluation.
authors.affiliation: Department of Neurology, University of California San Francisco, San Francisco, California, USA. akim@ucsf.edu
authors.forename: Anthony S
authors.initials: AS
authors.lastname: Kim
authors.forename: Sharon N
authors.initials: SN
authors.lastname: Poisson
authors.forename: J Donald
authors.initials: JD
authors.lastname: Easton
authors.forename: S Claiborne
authors.initials: SC
authors.lastname: Johnston
mesh_terms: D003430:Cross-Sectional Studies; D059026:Diagnostic Self Evaluation; D005260:Female; D006801:Humans; D057226:Information Seeking Behavior; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009862:Online Systems; D057566:Self Report; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology; D063189:Symptom Assessment; D014481:United States / Q000453:epidemiology