NICE advice on TIA referrals may be too tough

ABCD2 criteria for suspected TIA referral to rapid-access clinic will only pick up those patients at highest risk.

GPs may miss cases of TIA if they follow NICE draft guidelines on stroke, UK research findings suggest.

Draft guidelines issued in January said patients should be referred to a rapid access stroke clinic if they had an ABCD2 score of four or more.

However, research presented at the European Stroke Conference in Nice, France, this month suggested that, even with limited resources, a cut-off point of three would be best.

The study, at Glasgow Royal Infirmary's fast-track TIA clinic, audited all new patients using ABCD2 criteria, alongside clinical diagnostics in-cluding neuroimaging.

ABCD2 incorporates age, BP, clinical features such as speech disturbance, symptom duration and diabetes to provide an estimate of how likely a person is to have suffered a TIA. It uses a scale of zero to seven, with seven the highest risk.

Between July and September last year, 75 new patients, with an average age of 62, were referred to the clinic. Analysis showed median ABCD2 score for stroke and TIA was four, and two for other diagnoses.

Further analysis showed the sensitivity of an ABCD2 score of three or above for stroke or TIA was 88 per cent, with an odds ratio of 16.7.

Joe Korner, Stroke Association communications director and member of the NICE guideline development group, told GP that although 'health economics analysis showed it's probably cost-effective to check everyone', NICE decided on a cut-off that would avoid patients with symptoms mimicking a stroke being referred.

Manchester GP and member of the Intercollegiate Stroke Working Party Dr Helen Hos-ker said the difference between the cut-offs was 'marginal'.

'But whatever we do the ones at really high risk are going to be seen,' she said.

'We do need to have some cut-off so we don't have the clinics filled up with people who don't have TIA.'

European Stroke Conference 2008

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