Frequent inaccuracies in ABCD(2) scoring in non-stroke specialists' referrals to a daily Rapid Access Stroke Prevention service.

Hdl Handle:
http://hdl.handle.net/10147/299867
Title:
Frequent inaccuracies in ABCD(2) scoring in non-stroke specialists' referrals to a daily Rapid Access Stroke Prevention service.
Authors:
Bradley, David; Cronin, Simon; Kinsella, Justin A; Tobin, W Oliver; Mahon, Ciara; O'Brien, Margaret; Lonergan, Róisín; Cooney, Marie Therese; Kennelly, Sean; Collins, D Rónán; O'Neill, Desmond; Coughlan, Tara; Smyth, Shane; McCabe, Dominick J H
Affiliation:
Department of Neurology, The Adelaide and Meath Hospital, Dublin incorporating the National Children's Hospital, Trinity College Dublin, Ireland; Acute Stroke Service, The National Hospital for Neurology and Neurosurgery, London, UK.
Citation:
Frequent inaccuracies in ABCD(2) scoring in non-stroke specialists' referrals to a daily Rapid Access Stroke Prevention service. 2013, 332 (1-2):30-4 J. Neurol. Sci.
Publisher:
Elsevier
Journal:
Journal of the neurological sciences
Issue Date:
15-Sep-2013
URI:
http://hdl.handle.net/10147/299867
DOI:
10.1016/j.jns.2013.05.030
PubMed ID:
23871489
Abstract:
The 'accuracy' of age, blood pressure, clinical features, duration and diabetes (ABCD(2)) scoring by non-stroke specialists referring patients to a daily Rapid Access Stroke Prevention (RASP) service is unclear, as is the accuracy of ABCD(2) scoring by trainee residents. In this prospective study, referrals were classified as 'confirmed TIAs' if the stroke specialist confirmed a clinical diagnosis of possible, probable or definite TIA, and 'non-TIAs' if patients had a TIA mimic or completed stroke. ABCD(2) scores from referring physicians were compared with scores by experienced stroke specialists and neurology/geriatric medicine residents at a daily RASP clinic; inter-observer agreement was examined. Data from 101 referrals were analysed (mean age=60.0years, 58% male). The median interval between referral and clinic assessment was 1day. Of 101 referrals, 52 (52%) were 'non-TIAs': 45 (86%) of 52 were 'TIA mimics' and 7 (14%) of 52 were completed strokes. There was only 'fair' agreement in total ABCD(2) scoring between referring physicians and stroke specialists (κ=0.37). Agreement was 'excellent' between residents and stroke specialists (κ=0.91). Twenty of 29 patients scored as 'moderate to high risk' (score 4-6) by stroke specialists were scored 'low risk' (score 0-3) by referring physicians. ABCD(2) scoring by referring doctors is frequently inaccurate, with a tendency to underestimate stroke risk. These findings emphasise the importance of urgent specialist assessment of suspected TIA patients, and that ABCD(2) scores by non-stroke specialists cannot be relied upon in isolation to risk-stratify patients. Inter-observer agreement in ABCD(2) scoring was 'excellent' between residents and stroke specialists, indicating short-term training may improve accuracy.
Item Type:
Article
Language:
en
ISSN:
1878-5883

Full metadata record

DC FieldValue Language
dc.contributor.authorBradley, Daviden_GB
dc.contributor.authorCronin, Simonen_GB
dc.contributor.authorKinsella, Justin Aen_GB
dc.contributor.authorTobin, W Oliveren_GB
dc.contributor.authorMahon, Ciaraen_GB
dc.contributor.authorO'Brien, Margareten_GB
dc.contributor.authorLonergan, Róisínen_GB
dc.contributor.authorCooney, Marie Thereseen_GB
dc.contributor.authorKennelly, Seanen_GB
dc.contributor.authorCollins, D Rónánen_GB
dc.contributor.authorO'Neill, Desmonden_GB
dc.contributor.authorCoughlan, Taraen_GB
dc.contributor.authorSmyth, Shaneen_GB
dc.contributor.authorMcCabe, Dominick J Hen_GB
dc.date.accessioned2013-08-26T13:08:18Z-
dc.date.available2013-08-26T13:08:18Z-
dc.date.issued2013-09-15-
dc.identifier.citationFrequent inaccuracies in ABCD(2) scoring in non-stroke specialists' referrals to a daily Rapid Access Stroke Prevention service. 2013, 332 (1-2):30-4 J. Neurol. Sci.en_GB
dc.identifier.issn1878-5883-
dc.identifier.pmid23871489-
dc.identifier.doi10.1016/j.jns.2013.05.030-
dc.identifier.urihttp://hdl.handle.net/10147/299867-
dc.description.abstractThe 'accuracy' of age, blood pressure, clinical features, duration and diabetes (ABCD(2)) scoring by non-stroke specialists referring patients to a daily Rapid Access Stroke Prevention (RASP) service is unclear, as is the accuracy of ABCD(2) scoring by trainee residents. In this prospective study, referrals were classified as 'confirmed TIAs' if the stroke specialist confirmed a clinical diagnosis of possible, probable or definite TIA, and 'non-TIAs' if patients had a TIA mimic or completed stroke. ABCD(2) scores from referring physicians were compared with scores by experienced stroke specialists and neurology/geriatric medicine residents at a daily RASP clinic; inter-observer agreement was examined. Data from 101 referrals were analysed (mean age=60.0years, 58% male). The median interval between referral and clinic assessment was 1day. Of 101 referrals, 52 (52%) were 'non-TIAs': 45 (86%) of 52 were 'TIA mimics' and 7 (14%) of 52 were completed strokes. There was only 'fair' agreement in total ABCD(2) scoring between referring physicians and stroke specialists (κ=0.37). Agreement was 'excellent' between residents and stroke specialists (κ=0.91). Twenty of 29 patients scored as 'moderate to high risk' (score 4-6) by stroke specialists were scored 'low risk' (score 0-3) by referring physicians. ABCD(2) scoring by referring doctors is frequently inaccurate, with a tendency to underestimate stroke risk. These findings emphasise the importance of urgent specialist assessment of suspected TIA patients, and that ABCD(2) scores by non-stroke specialists cannot be relied upon in isolation to risk-stratify patients. Inter-observer agreement in ABCD(2) scoring was 'excellent' between residents and stroke specialists, indicating short-term training may improve accuracy.en_GB
dc.language.isoenen
dc.publisherElsevieren_GB
dc.rightsArchived with thanks to Journal of the neurological sciencesen_GB
dc.titleFrequent inaccuracies in ABCD(2) scoring in non-stroke specialists' referrals to a daily Rapid Access Stroke Prevention service.en_GB
dc.typeArticleen
dc.contributor.departmentDepartment of Neurology, The Adelaide and Meath Hospital, Dublin incorporating the National Children's Hospital, Trinity College Dublin, Ireland; Acute Stroke Service, The National Hospital for Neurology and Neurosurgery, London, UK.en_GB
dc.identifier.journalJournal of the neurological sciencesen_GB
dc.description.fundingOtheren
dc.description.provinceLeinsteren
dc.description.peer-reviewpeer-reviewen

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