Risky TIAs may be missed under NICE advice

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

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

But 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 including neuroimaging.

Between July and September last year, 75 new patients, aged an average of 62 years, were referred to the clinic.

Analysis showed that median ABCD2 score for stroke and TIA was four, and for other diagnoses was two. Further analysis showed that 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.

Dr Helen Hosker, Manchester GP and a member of the Intercollegiate Stroke Working Party, said the difference between the two cut-off points 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.'

rachel.liddle@haymarket.com

European Stroke Conference 2008

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