title: Inter-rater agreement analysis of the Precise Diagnostic Score for suspected transient ischemic attack.
abstract: BACKGROUND
  No definitive criteria are available to confirm the diagnosis of transient ischemic attack. Inter-rater agreement between physicians regarding the diagnosis of transient ischemic attack is low, even among vascular neurologists. We developed the Precise Diagnostic Score, a diagnostic score that consists of discrete and well-defined clinical and imaging parameters, and investigated inter-rater agreement in patients with suspected transient ischemic attack.
  
  
  METHODS
  Fellowship-trained vascular neurologists, blinded to final diagnosis, independently reviewed retrospectively identical history, physical examination, routine diagnostic studies, and brain magnetic resonance imaging (diffusion and perfusion images) from consecutive patients with suspected transient ischemic attack. Each patient was rated using the 8-point Precise Diagnostic Score score, composed of a clinical score (0-4 points) and an imaging score (0-4 points). The composite Precise Diagnostic Score determines a Precise Diagnostic Score Likelihood of Brain Ischemia Scale: 0-1 = unlikely, 2 = possible, 3 = probable, 4-8 = very likely.
  
  
  RESULTS
  Three raters reviewed data from 114 patients. Using Precise Diagnostic Score, all three raters scored a similar percentage of the clinical events as being "probable" or "very likely" caused by brain ischemia: 57, 55, and 58%. Agreement was high for both total Precise Diagnostic Score (intraclass correlation coefficient of 0.94) and for the Likelihood of Brain Ischemia Scale (agreement coefficient of 0.84).
  
  
  CONCLUSIONS
  Compared with prior studies, inter-rater agreement for the diagnosis of transient brain ischemia appears substantially improved with the Precise Diagnostic Score scoring system. This score is the first to include specific criteria to assess the clinical relevance of diffusion-weighted imaging and perfusion lesions and supports the added value of magnetic resonance imaging for assessing patients with suspected transient ischemic attack.
authors.affiliation: Department of Neurology & Neurologic Sciences, Stanford Stroke Center, Stanford University, Stanford, USA Stroke Center, Neurocentre (EOC) of Southern Switzerland, Lugano, Switzerland carlo.cereda@eoc.ch.
authors.forename: Carlo W
authors.initials: CW
authors.lastname: Cereda
authors.affiliation: Department of Neurology & Neurologic Sciences, Stanford Stroke Center, Stanford University, Stanford, USA.
authors.forename: Paul M
authors.initials: PM
authors.lastname: George
authors.affiliation: Department of Neurology & Neurologic Sciences, Stanford Stroke Center, Stanford University, Stanford, USA.
authors.forename: Manabu
authors.initials: M
authors.lastname: Inoue
authors.affiliation: Department of Neurology & Neurologic Sciences, Stanford Stroke Center, Stanford University, Stanford, USA.
authors.forename: Nirali
authors.initials: N
authors.lastname: Vora
authors.affiliation: Department of Neurology, Stroke Center, Hôpital Pierre-Paul Riquet, Toulouse, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Olivot
authors.affiliation: Department of Neurology & Neurologic Sciences, Stanford Stroke Center, Stanford University, Stanford, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Schwartz
authors.affiliation: Department of Neurology & Neurologic Sciences, Stanford Stroke Center, Stanford University, Stanford, USA.
authors.forename: Maarten G
authors.initials: MG
authors.lastname: Lansberg
authors.affiliation: Department of Neurology & Neurologic Sciences, Stanford Stroke Center, Stanford University, Stanford, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Kemp
authors.affiliation: Department of Neurology & Neurologic Sciences, Stanford Stroke Center, Stanford University, Stanford, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Mlynash
authors.affiliation: Department of Neurology & Neurologic Sciences, Stanford Stroke Center, Stanford University, Stanford, USA.
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Albers
mesh_terms: D000368:Aged; D001921:Brain / Q000473:pathology; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009462:Neurology; D055420:Perfusion Imaging; D010820:Physicians; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016037:Single-Blind Method
keywords: Transient ischemic attack; acute stroke; brain; diagnosis (MesH); magnetic resonance imaging