Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative (QUERI), Indianapolis, USA.
VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA.
BMC Neurol. 2022 Jul 12;22(1):256. doi: 10.1186/s12883-022-02776-1.
Risk-stratification tools that have been developed to identify transient ischemic attack (TIA) patients at risk of recurrent vascular events typically include factors which are not readily available in electronic health record systems. Our objective was to evaluate two TIA risk stratification approaches using electronic health record data.
Patients with TIA who were cared for in Department of Veterans Affairs hospitals (October 2015-September 2018) were included. The six outcomes were mortality, recurrent ischemic stroke, and the combined endpoint of stroke or death at 90-days and 1-year post-index TIA event. The cohort was split into development and validation samples. We examined the risk stratification of two scores constructed using electronic health record data. The Clinical Assessment Needs (CAN) score is a validated measure of risk of hospitalization or death. The PREVENT score was developed specifically for TIA risk stratification.
A total of N = 5250 TIA patients were included in the derivation sample and N = 4248 in the validation sample. The PREVENT score had higher c-statistics than the CAN score across all outcomes in both samples. Within the validation sample the c-statistics for the PREVENT score were: 0.847 for 90-day mortality, 0.814 for 1-year mortality, 0.665 for 90-day stroke, and 0.653 for 1-year stroke, 0.699 for 90-day stroke or death, and 0.744 for 1-year stroke or death. The PREVENT score classified patients into categories with extreme nadir and zenith outcome rates. The observed 1-year mortality rate among validation patients was 7.1%; the PREVENT score lowest decile of patients had 0% mortality and the highest decile group had 30.4% mortality.
The PREVENT score had strong c-statistics for the mortality outcomes and classified patients into distinct risk categories. Learning healthcare systems could implement TIA risk stratification tools within electronic health records to support ongoing quality improvement.
ClinicalTrials.gov Identifier: NCT02769338 .
为了识别短暂性脑缺血发作（TIA）患者发生复发性血管事件的风险，已经开发了风险分层工具，这些工具通常包括在电子健康记录系统中不易获得的因素。我们的目的是使用电子健康记录数据评估两种 TIA 风险分层方法。
纳入 2015 年 10 月至 2018 年 9 月期间在退伍军人事务部医院接受治疗的 TIA 患者。结局包括死亡率、复发性缺血性卒中和索引 TIA 事件后 90 天和 1 年时的卒中和死亡联合终点。该队列分为开发和验证样本。我们检查了两种使用电子健康记录数据构建的评分的风险分层。临床评估需求（CAN）评分是住院或死亡风险的有效衡量标准。预防评分是专门为 TIA 风险分层开发的。
共有 5250 名 TIA 患者纳入推导样本，4248 名患者纳入验证样本。在两个样本中的所有结局中，预防评分的 C 统计量均高于 CAN 评分。在验证样本中，预防评分的 C 统计量分别为：90 天死亡率为 0.847，1 年死亡率为 0.814，90 天卒中为 0.665，1 年卒中为 0.653，90 天卒中或死亡为 0.699，1 年卒中或死亡为 0.744。预防评分将患者分为结局极值的类别。验证患者的 1 年死亡率为 7.1%；预防评分最低十分位数的患者死亡率为 0%，最高十分位数组的死亡率为 30.4%。
预防评分对死亡率结局具有较强的 C 统计量，并将患者分为不同的风险类别。学习型医疗保健系统可以在电子健康记录中实施 TIA 风险分层工具，以支持持续的质量改进。
ClinicalTrials.gov 标识符：NCT02769338。
