The purpose of this study is to determine whether simple, evidence-based clinical screening be quickly and feasibly implemented (>85% of patients in an average of <6 minutes) in large-volume urgent transient ischemic attack (TIA)/stroke clinics to identify individuals at high risk for the three most common and devastating post-stroke co-morbidities (depression, obstructive sleep apnea and cognitive disorders).
We have created a simple screening tool (the "DOC" Screen) that will be routinely applied to all patients at a high-volume Regional Stroke Prevention Clinic. Consenting patients will also undergo "gold standard" research assessments in order to determine the diagnostic characteristics of the screen compared to gold standard research assessments.The proportion of eligible patients who complete DOC screening and the time for completion (mean, range, standard deviations) will be calculated from aggregated data for all new consults in the stroke prevention clinic. For patients who consented to undergo gold standard testing, sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratios of the DOC screen will be calculated. Screening cut-points will be optimized using Receiver Operating Characteristic (ROC) and area under the curve analysis, and logistic regression will be applied to this ROC Curve analysis to control for variables such as age, sex, BMI and education. We hope to develop a pragmatic approach to screening the large, high-risk stroke prevention clinic population, allowing broad screening for these important health conditions. This could change routine standard of care across stroke prevention clinics and facilitate early identification and appropriate assessment of patients.
- Observation: Cohort
- Perspective: Prospective
- Sampling: Non-Probability Sample
All consecutive patients attending outpatient TIA and Stroke Prevention Clinics.
|Type||Measure||Time Frame||Safety Issue|
|Primary||Number of Participants with any Adverse Event||1 year from initial screen date||No|
|Secondary||Number of Participants with recurrent stroke||1 year from initial screen||No|
|Secondary||Incidence of DOC co-morbidities||1 year from initial screen||No|
|Secondary||The number of participants with myocardial infarction||1 year from inital screening||No|
|Secondary||The number of participants who died.||1 year from initial visit||No|
|Secondary||Number of participants who have been admitted to a long-term care or complex continuing care facility||1 year from inital screen||No|
|Primary||Number of Participants with who completed the DOC Screen in 5 minutes or less||Day 1||No|
|Secondary||DOC Screen Diagnostic Characteristics compared to Gold Standard Research Assessments||Average 7 weeks||No|