Prognostic nomogram for patients with minor stroke and transient ischaemic attack

2020 ◽  
pp. postgradmedj-2020-137680
Author(s):  
Zhihao Lei ◽  
Shuanglin Li ◽  
Hongye Feng ◽  
Yupeng Lai ◽  
Yanxia Zhou ◽  
...  
Keyword(s):  
Transient Ischaemic Attack ◽  
Clinical Decision Making ◽  
Validation Cohort ◽  
Predictive Accuracy ◽  
Clinical Decision ◽  
Favourable Outcome ◽  
Minor Stroke ◽  
Derivation Cohort ◽  
Actual Observation ◽  
Ischaemic Attack

BackgroundIschaemic stroke and transient ischaemic attack (TIA) share a common cause. We aim to develop and validate a concise prognostic nomogram for patients with minor stroke and TIA.MethodsA total of 994 patients with minor stroke and TIA were included. They were split into a derivation (n=746) and validation (n=248) cohort. The modified Rankin Scale (mRS) scores 3 months after onset were used to assess the prognosis as unfavourable outcome (mRS≥2) or favourable outcome (mRS<2).ResultThe final model included seven independent predictors: gender, age, baseline National Institute of Health Stroke Scale (NIHSS), hypertension, diabetes mellitus, white blood cell and serum uric acid. The Harrell’s concordance index (C-index) of the nomogram for predicting the outcome was 0.775 (95% CI 0.735 to 0.814), which was confirmed by the validation cohort (C-index=0.787 (95% CI 0.722 to 0.853)). The calibration curve showed that the nomogram-based predictions were consistent with actual observation in both derivation cohort and validation cohort.ConclusionThe proposed nomogram showed favourable predictive accuracy for minor stroke and TIA. This has the potential to contribute to clinical decision-making.

scholarly journals A novel severity score to predict inpatient mortality in COVID-19 patients

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
David J. Altschul ◽  
Santiago R. Unda ◽  
Joshua Benton ◽  
Rafael de la Garza Ramos ◽  
Phillip Cezayirli ◽  
...  
Keyword(s):  
Severity Score ◽  
Clinical Decision Making ◽  
Risk Model ◽  
Validation Cohort ◽  
Clinical Decision ◽  
International Normalized Ratio ◽  
Severe Illness ◽  
Roc Curve Analysis ◽  
Derivation Cohort ◽  
Mortality Incidence

Abstract COVID-19 is commonly mild and self-limiting, but in a considerable portion of patients the disease is severe and fatal. Determining which patients are at high risk of severe illness or mortality is essential for appropriate clinical decision making. We propose a novel severity score specifically for COVID-19 to help predict disease severity and mortality. 4711 patients with confirmed SARS-CoV-2 infection were included. We derived a risk model using the first half of the cohort (n = 2355 patients) by logistic regression and bootstrapping methods. The discriminative power of the risk model was assessed by calculating the area under the receiver operating characteristic curves (AUC). The severity score was validated in a second half of 2356 patients. Mortality incidence was 26.4% in the derivation cohort and 22.4% in the validation cohort. A COVID-19 severity score ranging from 0 to 10, consisting of age, oxygen saturation, mean arterial pressure, blood urea nitrogen, C-Reactive protein, and the international normalized ratio was developed. A ROC curve analysis was performed in the derivation cohort achieved an AUC of 0.824 (95% CI 0.814–0.851) and an AUC of 0.798 (95% CI 0.789–0.818) in the validation cohort. Furthermore, based on the risk categorization the probability of mortality was 11.8%, 39% and 78% for patient with low (0–3), moderate (4–6) and high (7–10) COVID-19 severity score. This developed and validated novel COVID-19 severity score will aid physicians in predicting mortality during surge periods.

scholarly journals Development and Validation of a Simplified Risk Score for the Prediction of Critical COVID-19 Illness in Newly Diagnosed Patients

2021 ◽  
Author(s):  
Stanislas Werfel ◽  
Carolin E. M. Jakob ◽  
Stefan Borgmann ◽  
Jochen Schneider ◽  
Christoph Spinner ◽  
...  
Keyword(s):  
Critical Illness ◽  
Clinical Decision Making ◽  
Validation Cohort ◽  
Predictive Accuracy ◽  
Clinical Decision ◽  
Increased Risk ◽  
Risk Of Progression ◽  
Risk Of Disease ◽  
Development And Validation

AbstractScores for identifying patients at high risk of progression of the coronavirus disease 2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), are discussed as key instruments for clinical decision-making and patient management during the current pandemic.Here we used the patient data from the multicenter Lean European Open Survey on SARS-CoV-2 - Infected Patients (LEOSS) and applied a technique of variable selection in order to develop a simplified score to identify patients at increased risk of critical illness or death.A total of 1,946 patients, who were tested positive for SARS-CoV-2 were included in the initial analysis. They were split into a derivation and a validation cohort (n=1,297 and 649, respectively). A stability selection among a total of 105 baseline predictors for the combined endpoint of progression to critical phase or COVID-19-related death allowed us to develop a simplified score consisting of five predictors: CRP, Age, clinical disease phase (uncomplicated vs. complicated), serum urea and D-dimer (abbreviated as CAPS-D score). This score showed an AUC of 0.81 (CI95%: 0.77-0.85) in the validation cohort for predicting the combined endpoint within 7 days of diagnosis and 0.81 (CI95%: 0.77-0.85) during the full follow-up. Finally, we used an additional prospective cohort of 682 patients, who were diagnosed largely after the “first wave” of the pandemic to validate predictive accuracy of the score, observing similar results (AUC for an event within 7 days: 0.83, CI95%, 0.78-0.87; for full follow-up: 0.82, CI95%, 0.78-0.86).We thus successfully establish and validate an easily applicable score to calculate the risk of disease progression of COVID-19 to critical illness or death.

scholarly journals A Novel Severity Score to Predict Inpatient Mortality in COVID-19 patients

2020 ◽  
Author(s):  
David Altschul ◽  
Santiago R Unda ◽  
Joshua Benton ◽  
Rafael de La Garza Ramos ◽  
Mark Mehler ◽  
...  
Keyword(s):  
Severity Score ◽  
Clinical Decision Making ◽  
Risk Model ◽  
Validation Cohort ◽  
Clinical Decision ◽  
International Normalized Ratio ◽  
Severe Illness ◽  
Roc Curve Analysis ◽  
Derivation Cohort ◽  
Mortality Incidence

Abstract IntroductionCOVID-19 is commonly mild and self-limiting, but in a considerable portion of patients the disease is severe and fatal. Determining which patients are at high risk of severe illness or mortality is essential for appropriate clinical decision making. We propose a novel severity score specifically for COVID-19 to help predict disease severity and mortality.Methods4,711 patients with confirmed SARS-CoV-2 infection were included. We derived a risk model using the first half of the cohort (n=2,355 patients) by logistic regression and bootstrapping methods. The discriminative power of the risk model was assessed by calculating the area under the receiver operating characteristic curves (AUC). The severity score was validated in a second half of 2,356 patients.ResultsMortality incidence was 26.4% in the derivation cohort and 22.4% in the validation cohort. A COVID-19 severity score ranging from 0 to 10, consisting of age, oxygen saturation, mean arterial pressure, blood urea nitrogen, C-Reactive protein, and the international normalized ratio was developed. A ROC curve analysis was performed in the derivation cohort achieved an AUC of 0.824 (95% CI 0.814-0.851) and an AUC of 0.798 (95% CI 0.789-0.818) in the validation cohort. Furthermore, based on the risk categorization the probability of mortality was 11.8%, 39% and 78% for patient with low (0-3), moderate (4-6) and high (7-10) COVID-19 severity score.ConclusionThis developed and validated novel COVID-19 severity score will aid physicians in predicting mortality during surge periods.

Preoperative Score to Predict Postoperative Mortality (POSPOM)

2016 ◽  
Vol 124 (3) ◽  
pp. 570-579 ◽  
Author(s):  
Yannick Le Manach ◽  
Gary Collins ◽  
Reitze Rodseth ◽  
Christine Le Bihan-Benjamin ◽  
Bruce Biccard ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Risk Score ◽  
Clinical Decision Making ◽  
Validation Cohort ◽  
Postoperative Mortality ◽  
Clinical Decision ◽  
Derivation Cohort ◽  
International Statistical Classification ◽  
Hospital Deaths ◽  
Preoperative Score

Abstract Background An accurate risk score able to predict in-hospital mortality in patients undergoing surgery may improve both risk communication and clinical decision making. The aim of the study was to develop and validate a surgical risk score based solely on preoperative information, for predicting in-hospital mortality. Methods From January 1, 2010, to December 31, 2010, data related to all surgeries requiring anesthesia were collected from all centers (single hospital or hospitals group) in France performing more than 500 operations in the year on patients aged 18 yr or older (n = 5,507,834). International Statistical Classification of Diseases, 10th revision codes were used to summarize the medical history of patients. From these data, the authors developed a risk score by examining 29 preoperative factors (age, comorbidities, and surgery type) in 2,717,902 patients, and then validated the risk score in a separate cohort of 2,789,932 patients. Results In the derivation cohort, there were 12,786 in-hospital deaths (0.47%; 95% CI, 0.46 to 0.48%), whereas in the validation cohort there were 14,933 in-hospital deaths (0.54%; 95% CI, 0.53 to 0.55%). Seventeen predictors were identified and included in the PreOperative Score to predict PostOperative Mortality (POSPOM). POSPOM showed good calibration and excellent discrimination for in-hospital mortality, with a c-statistic of 0.944 (95% CI, 0.943 to 0.945) in the development cohort and 0.929 (95% CI, 0.928 to 0.931) in the validation cohort. Conclusion The authors have developed and validated POSPOM, a simple risk score for the prediction of in-hospital mortality in surgical patients.

scholarly journals Development of a Digital Lifestyle Modification Intervention for Use after Transient Ischaemic Attack or Minor Stroke: A Person-Based Approach

2021 ◽  
Vol 18 (9) ◽  
pp. 4861
Author(s):  
Neil Heron ◽  
Seán R. O’Connor ◽  
Frank Kee ◽  
David R. Thompson ◽  
Neil Anderson ◽  
...  
Keyword(s):  
Focus Group ◽  
Scoping Review ◽  
Transient Ischaemic Attack ◽  
Lifestyle Modification ◽  
Data Entry ◽  
Personal Control ◽  
Minor Stroke ◽  
User Engagement ◽  
Self Confidence ◽  
Ischaemic Attack

This paper describes the development of the ‘Brain-Fit’ app, a digital secondary prevention intervention designed for use in the early phase after transient ischaemic attack (TIA) or minor stroke. The aim of the study was to explore perceptions on usability and relevance of the app in order to maximise user engagement and sustainability. Using the theory- and evidence-informed person-based approach, initial planning included a scoping review of qualitative evidence to identify barriers and facilitators to use of digital interventions in people with cardiovascular conditions and two focus groups exploring experiences and support needs of people (N = 32) with a history of TIA or minor stroke. The scoping review and focus group data were analysed thematically and findings were used to produce guiding principles, a behavioural analysis and explanatory logic model for the intervention. Optimisation included an additional focus group (N = 12) and individual think-aloud interviews (N = 8) to explore perspectives on content and usability of a prototype app. Overall, thematic analysis highlighted uncertainty about increasing physical activity and concerns that fatigue might limit participation. Realistic goals and progressive increases in activity were seen as important to improving self-confidence and personal control. The app was seen as a useful and flexible resource. Participant feedback from the optimisation phase was used to make modifications to the app to maximise engagement, including simplification of the goal setting and daily data entry sections. Further studies are required to examine efficacy and cost-effectiveness of this novel digital intervention.

scholarly journals Usability and Acceptability of a Novel Secondary Prevention Initiative Targeting Physical Activity for Individuals after a Transient Ischaemic Attack or “Minor” Stroke: A Qualitative Study

2020 ◽  
Vol 17 (23) ◽  
pp. 8788
Author(s):  
Neil Heron ◽  
Sean R. O’Connor ◽  
Frank Kee ◽  
Jonathan Mant ◽  
Margaret E. Cupples ◽  
...  
Keyword(s):  
Physical Activity ◽  
Secondary Prevention ◽  
Transient Ischaemic Attack ◽  
Recurrence Risk ◽  
Relevant Information ◽  
Minor Stroke ◽  
Group Discussions ◽  
Self Evaluation ◽  
Ischaemic Attack ◽  
Optimal Approach

Behavioural interventions that address cardiovascular risk factors such as physical inactivity and hypertension help reduce recurrence risk following a transient ischaemic attack (TIA) or “minor” stroke, but an optimal approach for providing secondary prevention is unclear. After developing an initial draft of an innovative manual for patients, aiming to promote secondary prevention following TIA or minor stroke, we aimed to explore views about its usability and acceptability amongst relevant stakeholders. We held three focus group discussions with 18 participants (people who had experienced a TIA or minor stroke (4), carers (1), health professionals (9), and researchers (4). Reflexive thematic analysis identified the following three inter-related themes: (1) relevant information and content, (2) accessibility of format and helpful structure, and (3) strategies to optimise use and implementation in practice. Information about stroke, medication, diet, physical activity, and fatigue symptoms was valued. Easily accessed advice and practical tips were considered to provide support and reassurance and promote self-evaluation of lifestyle behaviours. Suggested refinements of the manual’s design highlighted the importance of simplifying information and providing reassurance for patients early after a TIA or minor stroke. Information about fatigue, physical activity, and supporting goal setting was viewed as a key component of this novel secondary prevention initiative.

scholarly journals Validation of parsimonious prognostic models for patients infected with COVID-19

2021 ◽  
Vol 28 (1) ◽  
pp. e100267
Author(s):  
Keerthi Harish ◽  
Ben Zhang ◽  
Peter Stella ◽  
Kevin Hauck ◽  
Marwa M Moussa ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Validation Cohort ◽  
External Validation ◽  
Clinical Decision ◽  
Prognostic Models ◽  
Clinical Prediction ◽  
Inclusion Criteria ◽  
Local Data ◽  
External Data ◽  
Operator Curve

ObjectivesPredictive studies play important roles in the development of models informing care for patients with COVID-19. Our concern is that studies producing ill-performing models may lead to inappropriate clinical decision-making. Thus, our objective is to summarise and characterise performance of prognostic models for COVID-19 on external data.MethodsWe performed a validation of parsimonious prognostic models for patients with COVID-19 from a literature search for published and preprint articles. Ten models meeting inclusion criteria were either (a) externally validated with our data against the model variables and weights or (b) rebuilt using original features if no weights were provided. Nine studies had internally or externally validated models on cohorts of between 18 and 320 inpatients with COVID-19. One model used cross-validation. Our external validation cohort consisted of 4444 patients with COVID-19 hospitalised between 1 March and 27 May 2020.ResultsMost models failed validation when applied to our institution’s data. Included studies reported an average validation area under the receiver–operator curve (AUROC) of 0.828. Models applied with reported features averaged an AUROC of 0.66 when validated on our data. Models rebuilt with the same features averaged an AUROC of 0.755 when validated on our data. In both cases, models did not validate against their studies’ reported AUROC values.DiscussionPublished and preprint prognostic models for patients infected with COVID-19 performed substantially worse when applied to external data. Further inquiry is required to elucidate mechanisms underlying performance deviations.ConclusionsClinicians should employ caution when applying models for clinical prediction without careful validation on local data.

Abstract P208: Transient Ischaemic Attack: How the Patient Perceives it

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Mary J MacLeod ◽  
Ali Abdullah
Keyword(s):  
Secondary Prevention ◽  
Transient Ischaemic Attack ◽  
Patient Adherence ◽  
Behavioural Change ◽  
Illness Perception ◽  
Personal Control ◽  
Self Report ◽  
Minor Stroke ◽  
Medical Attention ◽  
Ischaemic Attack

Background: The risk of stroke after Transient Ischaemic Attack (TIA) is 8-11 % within a month. Rapid assessment and early use of preventative therapies can reduce this risk by 80-90%. Many patients do not seek timely medical attention, and may minimise their symptoms. The purpose of this study was to assess patients' perception of the significance of TIA/ minor stroke, and their beliefs and attitudes to secondary prevention interventions. Methods: 120 patients with a recent TIA/minor stroke were given a questionnaire after clinic/ward review. This included the validated Brief Illness Perception Questionnaire (Brief-IPQ: scores 0-10), and Beliefs about Medicines Questionnaire (BMQ: scores 5-25). Patient adherence to secondary prevention medications was assessed by self-report. Results: There was a 56% return rate. Within the brief-IPQ, patients had a mid score for perceived consequences of their event (4.88 (sd2.67)). Only 22% took urgent action at the time of the event. 60% were persuaded to take action by family or friends. Patients scored the midpoint for emotional distress (4.9 (sd 3.4)) and felt they could not exert personal control (4.0(3.2)). They did believed treatment would control their condition (7.7(2.1)). The majority of patients (86.3%) believed in the necessity of medication, with mean necessity score of 18.36(3.5). 14% reported concerns about becoming dependent upon medications and the potential adverse consequences of taking medication. 78% of patients said they complied with their treatment. Conclusions: Patients may not regard TIA or minor stroke as having important implications for their future health. Many only seek medical advice as a result of external pressure. Patients do not feel they have personal control over the condition, but believe medication is necessary and beneficial. These findings will inform strategies for education and behavioural change interventions in people at risk of or who have had a TIA/minor stroke

scholarly journals Rehabilitation of patients after transient ischaemic attack or minor stroke: pilot feasibility randomised trial of a home-based prevention programme

2019 ◽  
Vol 69 (687) ◽  
pp. e706-e714 ◽  
Author(s):  
Neil Heron ◽  
Frank Kee ◽  
Jonathan Mant ◽  
Margaret E Cupples ◽  
Michael Donnelly
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Secondary Prevention ◽  
Cardiovascular Risk Factors ◽  
Transient Ischaemic Attack ◽  
Standard Care ◽  
Minor Stroke ◽  
Home Based ◽  
Ischaemic Attack

BackgroundAlthough the importance of secondary prevention after transient ischaemic attack (TIA) or minor stroke is recognised, research is sparse regarding novel, effective ways in which to intervene in a primary care context.AimTo pilot a randomised controlled trial (RCT) of a novel home-based prevention programme (The Healthy Brain Rehabilitation Manual) for patients with TIA or ‘minor’ stroke.Design and settingPilot RCT, home-based, undertaken in Northern Ireland between May 2017 and March 2018.MethodPatients within 4 weeks of a first TIA or ‘minor’ stroke received study information from clinicians in four hospitals. Participants were randomly allocated to one of three groups: standard care (control group) (n = 12); standard care with manual and GP follow-up (n = 14); or standard care with manual and stroke nurse follow-up (n = 14). Patients in all groups received telephone follow-up at 1, 4, and 9 weeks. Eligibility, recruitment, and retention were assessed; stroke/cardiovascular risk factors measured at baseline and 12 weeks; and participants’ views were elicited about the study via focus groups.ResultsOver a 32-week period, 28.2% of clinic attendees (125/443) were eligible; 35.2% of whom (44/125) consented to research contact; 90.9% of these patients (40/44) participated, of whom 97.5% (39/40) completed the study. After 12 weeks, stroke risk factors [cardiovascular risk factors, including blood pressure and measures of physical activity] improved in both intervention groups. The research methods and the programme were acceptable to patients and health professionals, who commented that the programme ‘filled a gap’ in current post-TIA management.ConclusionFindings indicate that implementation of this novel cardiac rehabilitation programme, and of a trial to evaluate its effectiveness, is feasible, with potential for clinically important benefits and improved secondary prevention after TIA or ‘minor’ stroke.

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