Abstract
BackgroundA Transient Ischaemic Attack (TIA) bears a high risk of a subsequent ischaemic stroke. Adequate diagnosis of a TIA should be followed immediately by the start of appropriate preventive therapy, including antiplatelets. The diagnosis of a TIA based on symptoms and signs only is notoriously difficult and biomarkers of brain ischaemia might improve the recognition, and target management and prognosis of TIA patients. Our aim is to quantify the added diagnostic value of serum biomarkers of brain ischaemia in patients suspected of TIA.Methods/designStudy design: a cross-sectional diagnostic accuracy study with an additional six month follow-up period.Study population: 350 patients suspected of TIA in the primary care setting.Patients suspected of a TIA will be recruited by at least 200 general practitioners (GPs) in the catchment area of seven TIA outpatient clinics willing to participate in the study. In all patients a blood sample will be drawn as soon as possible after the patient has contacted the GP, but at least within 72 h after onset of symptoms. Participants will be referred by the GP to the regional TIA outpatient clinic for additional investigations, including brain imaging. The ‘definite’ diagnosis (reference standard) will be made by a panel consisting of three experienced neurologists who will use all available diagnostic information and the clinical information obtained during the outpatient clinic assessment, and a six month follow-up period. The diagnostic accuracy, and value in addition to signs and symptoms of candidate serum biomarkers will be assessed in terms of discrimination with C statistics, and calibration with plots.We aim to include 350 suspected cases, with 250 patients with indeed definite TIA (or minor stroke) according to the panel.DiscussionWe hope to find novel biomarkers that will enable a rapid and accurate diagnosis of TIA. This would largely improve the management and prognosis of such patients.Trial registrationClinicalTrials.gov Identifier NCT01954329
Highlights
A Transient Ischaemic Attack (TIA) bears a high risk of a subsequent ischaemic stroke
A rapid start of treatment may be hampered by patient and physician delay, waiting time involved in referral to the TIA outpatient clinic, and difficulties in establishing the correct diagnosis
Patients are recruited within 72 h after symptom onset and either directly after their general practitioners (GPs) consultation or at the time they visit the TIA outpatient clinic after referral by the GP
Summary
A Transient Ischaemic Attack (TIA) bears a high risk of a subsequent ischaemic stroke. Our aim is to quantify the added diagnostic value of serum biomarkers of brain ischaemia in patients suspected of TIA. A Transient Ischaemic Attack (TIA) by definition does not result in permanent damage of brain tissue [2], but the risk of a subsequent ischaemic stroke is substantial, especially within the first 2 weeks. Recent studies underline the fact that TIA is a medical emergency [6] and adequate antithrombotic treatment reduces disability and health care related costs [7]. A rapid start of treatment may be hampered by patient and physician delay, waiting time involved in referral to the TIA outpatient clinic, and difficulties in establishing the correct diagnosis
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