Abstract
BackgroundIndividuals with TIA/stroke symptoms often do not seek urgent medical attention. We assessed the feasibility of identifying individuals searching for information on TIA/stroke symptoms online as a target for future interventions to encourage urgent evaluation and we evaluated the performance of a self-reported risk score to identify subjects with true TIA or stroke.Methodology/Principal FindingsWe placed online advertisements to target English-speaking adults in the United States searching for TIA/stroke-related keywords. After completing an online questionnaire, participants were telephoned by a vascular neurologist to assess the likelihood of TIA/stroke. We used logistic regression and the c-statistic to assess associations and model discrimination respectively. Over 122 days, 251 (1%) of 25,292 website visitors completed the online questionnaire and 175 were reached by telephone (mean age 58.5 years; 63% women) for follow-up. Of these participants, 37 (21%) had symptoms within 24 hours, 60 (34%) had not had a medical evaluation yet, and 68 (39%) had TIA/stroke. Applying a modified ABCD2 score yielded a c-statistic of 0.66, but 2 of 12 with a zero score had a TIA/stroke. Those with new symptoms were more likely to have TIA/stroke (OR 4.90, 95% CI 2.56−9.09).Conclusions/SignificanceIndividuals with TIA/stroke that are seeking real-time information on symptoms online can be readily identified, in some cases before they have sought formal medical evaluation. Although a simple self-reported risk score was unable to identify a low-risk population in this selected group, this population may still present an attractive target for future interventions designed to encourage urgent medical evaluation.
Highlights
[9] Transient ischemic attack (TIA) or ‘‘mini-stroke’’, as it is commonly known in the lay public, may not be recognized as a harbinger of stroke, when symptoms are transitory or evanescent. [9,10] So even when TIA or stroke is considered as a possibility, the importance of an urgent evaluation may not be fully appreciated
Individuals seeking appropriate evaluation may be deterred by barriers to access to healthcare providers, on weekends or evenings [11] or by the prospect of lengthy or costly emergency department visits for symptoms that may be perceived of as minor or transient. [12,13] improving early recognition of TIA and an appreciation for the substantial risk of stroke associated with TIA may help to reduce delays in presentation for medical evaluation and create additional opportunities to prevent stroke
Our primary goal was to assess the feasibility of identifying a population of individuals that are searching for information on TIA/stroke online as a potential target for future interventions to encourage appropriate urgent medical evaluation
Summary
Transient ischemic attack (TIA) is associated with a high risk of subsequent stroke, in the first hours after symptom onset. [1,2] progress has been made to develop simple clinical scores to rapidly identify TIA patients at high risk of stroke [3] and to apply urgent interventions to prevent stroke after TIA, [4,5,6] most individuals with TIA do not seek urgent medical evaluation. [7,8]. [12,13] improving early recognition of TIA and an appreciation for the substantial risk of stroke associated with TIA may help to reduce delays in presentation for medical evaluation and create additional opportunities to prevent stroke. Within this context, the internet has become an increasingly important source of first-line medical information [14] in part due to widespread availability and relatively low barriers to access. Our secondary goal was to assess the performance of a web-based self-assessment tool based on the ABCD2 score to identify TIA/stroke [16] in this population with the hope that this personalized information would be a more effective motivation for participants to seek appropriate medical attention than general advice on TIA
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