Diagnosis of transient ischemic attack by the nonneurologist - A validation study
Diagnosis of transient ischemic attack by the nonneurologist - A validation study
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DOI：
10.1161/01.str.27.12.2225
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发表时间：
1996-12-01
期刊：
影响因子：
8.3
通讯作者：
Salgado, AV
中科院分区：
文献类型：
--
作者：
Ferro, JM;Falcao, I;Salgado, AV
背景与目的短暂性脑缺血发作（TIA）诊断的观察者间可靠性较低，非神经科医师对TIA的诊断常常是错误的。我们试图验证全科医生（gp）和医院急诊医生（急诊MDs）对TIA的诊断。方法将20种神经系统症状分发给20名全科医生和22名神经科医生，并对每种症状与TIA诊断的相容性进行评分。至少有两名神经科医生证实了全科医生对他们治疗的患者或急诊医学博士做出的TIA诊断。结果与神经科医生相比，全科医生认为“精神错乱”和“不明原因的跌倒”更容易与TIA合并，而“下面瘫”和“单眼失明”更不容易与TIA合并。10例患者（19%）经全科医生确诊；26例患者有中风，16例（31%）有非脑血管疾病。4例患者（13%）通过急诊MD确诊；10例患者有中风，17例（55%）有非脑血管疾病。最常被误诊为tia的情况是短暂的意识、精神状态和平衡障碍。结论神经科医师和非神经科医师对TIA概念的理解不同。全科医生和急诊医学博士通常将轻微中风和几种非血管性短暂性神经紊乱标记为tia。在这种对TIA的误解被改变之前，在转诊医生和神经科医生之间的交流中应该避免使用TIA这个词。如果不转诊给神经科医生，三分之一到一半被诊断为TIA的患者将被不恰当地处理。
Background and Purpose Interobserver reliability of the diagnosis of transient ischemic attack (TIA) is low, and diagnosis of TIA made by nonneurologists is often erroneous. We sought to validate the diagnosis of TIA made by general practitioners (GPs) and by hospital emergency service physicians (emergency MDs).Methods A list of 20 neurological symptoms was distributed to 20 GPs and 22 neurologists who graded the compatibility of each symptom with the TIA diagnosis. At least two neurologists validated TIA diagnoses made by GPs for patients under their care or by emergency MDs.Results Compared with neurologists, GPs considered ''confusion'' and ''unexplained fall'' more often compatible with TIA and ''lower facial palsy'' and ''monocular blindness'' less often compatible with TIA. Validation of diagnosis by GP was confirmed in 10 patients (19%); 26 patients had strokes, and 16 (31%) had a noncerebrovascular disorder. Validation of diagnosis by emergency MD was confirmed in 4 patients (13%); 10 patients had strokes, and 17 (55%) had noncerebrovascular disorders. The most frequent conditions misdiagnosed as TIAs were transient disturbances of consciousness, mental status, and balance.Conclusions The TIA concept is understood differently by neurologists and nonneurologists. GPs and emergency MDs often label minor strokes and several nonvascular transient neurological disturbances as TIAs. Until this misconception of TIA is changed, the term TIA should probably be avoided in the communication between referring physicians and neurologists. If not referred to a neurologist, one third to one half of patients labeled with a diagnosis of TIA will be inappropriately managed.