August 27, 2019
Diagnosing transient ischemic attack (TIA) can be challenging. But with its strong sensitivity and negative predictive value, the Explicit Diagnostic Criteria for TIA (EDCT) might be a solid option for the diagnosis of TIA, according to a new study.
To evaluate whether the EDCT—which is based on clinical practice and experience instead of statistical methods—is a valuable diagnostic tool for the clinical diagnosis of TIA, the researchers evaluated data from the Markers in the Diagnosis of TIA (MIND-TIA) study. The study comprised 206 individuals who had visited a general practitioner and who were subsequently referred to a TIA service in the region of Utrecht, the Netherlands, for suspected TIA.
Within 72 hours of the TIA’s onset, a research nurse recorded the participants’ TIA-related signs and symptoms via a standardized questionnaire. Based on the available diagnostic information, which included the questionnaire results and a 6-month follow-up period, 3 stroke neurologists determined the definite diagnosis.
After 2 researchers scored the EDCT, and using the panel diagnosis as reference, the researchers assessed for the sensitivity, specificity, and predictive values of the EDCT. Finally, a secondary analysis was performed with modified subcriteria of the EDCT.
In all, 104 participants had a TIA and 22 had a minor stroke. Another 80 participants received an alternative diagnosis, which was most commonly migraine with aura (n = 24), stress-related or somatoform symptoms (n = 16), or syncope (n = 9).
In their evaluation of the diagnostic accuracy of the EDCT, the researchers determined that the criteria had a sensitivity of 98.4% and a specificity of 61.3%. The negative predictive value was 96.1%, while the positive predictive value was 80.0%.
After altering the EDCT so that the C-criteria were rephrased, the researchers determined that the modified criteria had a higher specificity of 73.8%, the same sensitivity, a similar negative predictive value of 96.7%, and a higher positive predictive value of 85.5%.
“This study showed that the original, and especially the proposed modified EDCT, are easy to apply and have excellent diagnostic properties in patients suspected of TIA in primary care,” the researchers concluded. “They could be a valuable diagnostic tool for use in primary care and emergency departments as well as being a valuable supplement in TIA clinics.”
Dolmans LS, Lebedeva ER, Veluponnar D, et al; MIND-TIA Study Group. Diagnostic accuracy of the explicit diagnostic criteria for transient ischemic attack: a validation study. Stroke. 2019;50(8):2080-2085. doi:10.1161/STROKEAHA.119.025626.