Abstract
Most patients with transient ischaemic attack (TIA) present to their GP. Early identification and treatment reduces the risk of subsequent stroke and consequent disability and mortality. To explore GPs' views on the diagnosis and immediate management of suspected TIA, and the potential utility of a diagnostic tool. This is a qualitative interview study based in Leicestershire, UK. A purposive sample of 10 GPs participated in 30-minute semi-structured telephone interviews. Data were analysed thematically. GPs reported that TIA was more likely to be suspected when patients were more obvious candidates for TIA based on their history, characteristics and symptom presentation. Referrals were in part a strategy to manage risk under conditions of uncertainty and to seek reassurance. GPs valued using a TIA risk stratification tool but felt this did not inform their diagnostic decision making. A diagnostic tool for TIA in primary care was seen to have potential to improve the decision-making process about diagnosis and management and enhance confidence of GPs, particularly in ruling out TIAs. GPs saw benefits of using hard thresholds, but remained concerned about missing TIAs and saw a tool as an adjunct to clinical judgement. GPs weigh up the likelihood of TIA in the context of assessments of candidacy and diverse, often vague, symptoms. A diagnostic tool could support GPs in this process and help reduce reliance on referrals to TIA clinics for reassurance, provided the tool was designed to support decision making in cases of less 'typical' presentations.
Highlights
Transient ischemic attacks (TIAs) are defined as temporary episodes of focal brain dysfunction of presumed vascular aetiology, lasting less than 24 hours, with no evidence of cerebral infarction 1
general practitioner (GP) reported that TIA was more likely to be suspected when patients were more obvious candidates for TIA based on their history, characteristics, and symptom presentation
GPs weigh up the likelihood of TIA in the context of assessments of candidacy, and diverse, often vague, symptoms
Summary
Transient ischemic attacks (TIAs) are defined as temporary episodes of focal brain dysfunction of presumed vascular aetiology, lasting less than 24 hours, with no evidence of cerebral infarction 1. The high number of patients referred to TIA clinic who turn out not to have suffered a TIA or stroke 19, coupled with evidence that some TIAs are missed or undertreated 14,15, highlights the possible value of education and a decision support tool for GPs in diagnosing and managing suspected TIA. The only published diagnostic tool for TIA (at the time of the systematic review) was the Dawson score, 22 developed in the context of secondary care. This tool has the potential to be utilised to reduce the number of non-cerebrovascular referrals to a fast track TIA service, by aiding GPs with the diagnosis of suspected TIA patients. Identification and treatment reduces the risk of subsequent stroke and consequent disability and mortality
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