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The ASPIRE Approach for TIA Risk Stratification

Published online by Cambridge University Press:  23 July 2018

S. B. Coutts ,
P. N. Sylaja ,
Y. B. Choi ,
A. Al-Khathami ,
C. SivaKumar ,
T.J. Jeerakathil ,
P. S. Sarma  and
M. D. Hill
S. B. Coutts
Affiliation:
Calgary Stroke Program, University of Calgary; Calgary Departments of Clinical Neurosciences, University of Calgary; Calgary Radiology, University of Calgary; Calgary
P. N. Sylaja
Affiliation:
Stroke Unit, Ananthapuri Hospitals and Research Institute
Y. B. Choi
Affiliation:
St. Louis University Hospital, St. Louis, Missouri, USA
A. Al-Khathami
Affiliation:
King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
C. SivaKumar
Affiliation:
Medicine, University of Calgary; Calgary
T.J. Jeerakathil
Affiliation:
Division of Neurology, University of Alberta, Edmonton. Albert Canada
P. S. Sarma
Affiliation:
Sree Chitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
M. D. Hill*
Affiliation:
Calgary Stroke Program, University of Calgary; Calgary Departments of Clinical Neurosciences, University of Calgary; Calgary Radiology, University of Calgary; Calgary Community Health Sciences, University of Calgary; Calgary Medicine, University of Calgary; Calgary
*
Foothills Hospital, Room 1242A, 1403-29 Street N.W., Calgary, Alberta, T2N 2T9, Canada
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Abstract:

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Background:

The risk of stroke after transient ischemic attack (TIA) is elevated in the days to weeks after TIA. A variety of prediction rules to predict stroke risk have been suggested. In Alberta a triage algorithm to facilitate urgent access based on risk level was agreed upon for the province. Patients with ABCD2 score ≥ 4, or motor or speech symptoms lasting greater than five minutes, or with atrial fibrillation were considered high risk (the ASPIRE approach). We assessed the ability of the ASPIRE approach to identify patients at risk for stroke.

Methods:

We retrospectively reviewed charts from 573 consecutive patients diagnosed with TIA in Foothills Hospital emergency room from 2002 through 2005. We recorded clinical and event details and identified the risk of stroke at three months.

Results:

Among 573 patients the 90-day risk of stroke was 4.7% (95% CI 3.0%, 6.4%). 78% of the patients were identified as high risk using this approach. In patients defined as high risk on the ASPIRE approach there was a 6.3% (95% CI 4.2%, 8.9%) risk of stroke. In patients defined as low risk using the ASPIRE approach there were no recurrent strokes (100% negative predictive value). In contrast, two patients with low ABCD2 scores (ABCD2 score < 4) suffered recurrent strokes.

Conclusions:

The ASPIRE approach has a perfect negative predictive value in the population in predicting stroke. However, this high sensitivity comes at a cost of identifying most patients as high risk.

Résumé:

Résumé:Contexte:

Le risque d'accident vasculaire cérébral (AVC) après une ischémie cérébrale transitoire (ICT) demeure élevé dans les jours ou les semaines qui suivent l'ICT. Plusieurs méthodes de prédiction de l'AVC ont été suggérées. En Alberta, un algorithme de triage a été accepté dans toute la province, pour faciliter un accès hospitalier urgent basé sur le niveau de risque. Les patients dont le score ABCD2 est de 4 ou plus, ou qui ont des symptomes moteurs ou du langage, ou de la fibrillation auriculaire sont considérés comme étant à haut risque (approche ASPIRE). Nous avons évalué la capacité de l'approche ASPIRE à identifier les patients à risque d'AVC

Méthodes:

Nous avons révisé rétrospectivement les dossiers de 573 patients consécutifs chez qui un diagnostic d'ICT avait été posé à l'urgence du Foothills Hospital de 2002 à la fin de 2005. Nous avons relevé en détail les informations cliniques et les informations concernant l'événement et nous avons identifié le risque d'AVC à trois mois.

Résultats:

Chez les 573 patients, le risque d'AVC était de 4,7% (IC à 95% : 3,0% à 6,4%) au cours des 90 premiers jours ; 78% des patients ont été identifiés comme étant à haut risque selon cette approche. Chez les patients considérés à haut risque selon l'approche ASPIRE, le risque d'AVC était de 6,3% (IC à 95% : 4,2% à 8,9%) et chez ceux considérés à faible risque selon cette approche il n'y a pas eu d'AVC (valeur prédictive négative de 100%). Par contre, deux patients ayant un score ABCD2 has (score ABCD2 < 4) ont subi un AVC récurrent,

Conclusions:

L'approche ASPIRE a une valeur prédictive négative parfaite pour prédire l'AVC dans cette population. Cependant, le coût de cette sensibilité est d'identifier la plupart des patients comme étant à risque élevé.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 38 , Issue 1 , January 2011 , pp. 78 - 81
Copyright
Copyright © Canadian Neurological Sciences Federation 2011

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