Departments of Neurology and Epidemiology, University of Washington, Seattle, Washington, USA.
Department of Biostatistics, University of Washington, Seattle, Washington, USA.
Neuroepidemiology. 2018;50(1-2):23-28. doi: 10.1159/000486174. Epub 2018 Jan 11.
To describe adjudication of transient ischemic attack (TIA) and stroke in an observational study.
We detail the process used to adjudicate TIA and stroke in the Multi-Ethnic Study of Atherosclerosis (MESA), a large longitudinal cohort study. Two of three vascular neurologists adjudicated each event using specific protocols. We examined the initial agreement, effect of imaging on diagnosis of TIA versus ischemic stroke, and effect of strict and less strict criteria on the number of ischemic stroke subtypes classified as undetermined.
Of 573 adjudicated events over 13.5 years of follow-up, 95 (16.5%) had TIA and 269 (47.0%) had stroke: 211 (78.4%) ischemic, 43 (16.0%) hemorrhagic, and 15 (5.6%) other. Disagreements occurred on 16% of initial adjudication of events. Using results from imaging, the number with TIA decreased by 8.6% and with ischemic stroke increased by 4.1%. Using less strict criteria to classify ischemic stroke subtypes reduced the number classified as undetermined, from 137 to 59, and numbers classified as cardioembolic and small vessel doubled.
We hope that this work will motivate and facilitate investigators to use MESA data to investigate issues concerning TIA and stroke and will inform investigators seeking to adjudicate TIA and stroke in other studies.
描述观察性研究中的短暂性脑缺血发作（TIA）和中风的裁决。
我们详细介绍了在动脉粥样硬化多民族研究（MESA）中裁决 TIA 和中风的过程，这是一项大型纵向队列研究。三位血管神经病学家中的两位根据具体方案裁决了每一个事件。我们检查了初始一致性、影像学对 TIA 与缺血性中风诊断的影响，以及严格和宽松标准对分类为未确定的缺血性中风亚型数量的影响。
在 13.5 年的随访中，573 例裁决事件中，95 例（16.5%）为 TIA，269 例（47.0%）为中风：211 例（78.4%）为缺血性，43 例（16.0%）为出血性，15 例（5.6%）为其他类型。初始裁决事件中有 16%存在分歧。使用影像学结果，TIA 的数量减少了 8.6%，缺血性中风的数量增加了 4.1%。使用更宽松的标准来分类缺血性中风亚型，将未确定的数量从 137 例减少到 59 例，而心源性栓塞和小血管的数量则增加了一倍。
我们希望这项工作将激励和促进研究人员使用 MESA 数据来研究与 TIA 和中风相关的问题，并为其他研究中裁决 TIA 和中风的研究人员提供信息。
