Wilson A, Potter J, Taub N, Moore A, Robinson T
Department of Health Sciences, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK.
Age Ageing. 2005 Jan;34(1):30-5. doi: 10.1093/ageing/afh229. Epub 2004 Nov 3.
Transient ischaemic attacks (TIAs) and minor strokes are important to diagnose as there are effective secondary preventive interventions. Significant under-reporting by patients occurs, but general practitioners tend to over-diagnose the condition, contributing in part to long clinic waiting lists. An accurate screening test could address both these problems.
A modified version of a questionnaire designed to detect TIA was tested against the gold standard of specialist diagnosis in two vascular outpatient clinics in Leicester, UK.
The questionnaire was sent by post with the clinic appointment and completed by 136 participants. In 99 cases the same questionnaire was administered by a clinic nurse. Overall levels of agreement (kappa, 95% CI) with specialist diagnosis of TIA, stroke or neither were 0.32 (0.15, 0.48) and 0.31 (0.12, 0.50) for postal and administered questionnaires, respectively. When the diagnoses of TIA and stroke were combined, agreement rose to 0.38 (0.23, 0.53) for postal and 0.38 (0.20, 0.57) for administered versions. For this outcome, the postal version had a sensitivity of 0.56 (0.43, 0.68) and specificity of 0.81 (0.71, 0.90). Equivalent figures for administered questionnaires were 0.61 (0.46, 0.76) and 0.76 (0.63, 0.87).
The questionnaire has potential in prioritising outpatient referrals but is not sufficiently specific to be used for research or population screening.
短暂性脑缺血发作（TIA）和轻度中风的诊断很重要，因为有有效的二级预防干预措施。患者存在大量漏报情况，但全科医生往往对该病过度诊断，这在一定程度上导致了门诊候诊名单过长。一种准确的筛查测试可以解决这两个问题。
在英国莱斯特的两家血管门诊，针对旨在检测TIA的问卷的修改版，对照专科诊断的金标准进行了测试。
问卷随门诊预约一同邮寄，136名参与者完成了问卷。在99例病例中，由门诊护士发放相同问卷。对于TIA、中风或两者皆无的专科诊断，邮寄问卷和发放问卷的总体一致性水平（kappa值，95%置信区间）分别为0.32（0.15，0.48）和0.31（0.12，0.50）。当将TIA和中风的诊断合并时，邮寄问卷的一致性升至0.38（0.23，0.53），发放问卷的一致性升至0.38（0.20，0.57）。对于这一结果，邮寄版问卷的灵敏度为0.56（0.43，0.68），特异度为0.81（0.71，0.90）。发放问卷的相应数据为0.61（0.46，0.76）和0.76（0.63，0.87）。
该问卷在确定门诊转诊优先级方面具有潜力，但特异性不足，无法用于研究或人群筛查。
