Post-stroke Triage "DOC": Simple Screening for Depression, Obstructive Sleep Apnea and Cognitive Impairment

Completed

Phase N/A Results N/A

Update History

26 Nov '15
The Summary of Purpose was updated.
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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).
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The purpose of this study is to determine whether simple, evidence-based clinical screening for the three most common and important post-stroke comorbidities (depression, obstructive sleep apnea and cognitive disorders) can add to clinical and demographic data to predict the occurrence of a composite negative outcome (any of: recurrent stroke, myocardial infarction, death, or admission to a long-term care (LTC) / complex continuing care (CCC) facility) within one year of screening, in large-volume stroke prevention clinics.
The description was updated.
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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.
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The DOC screen will be routinely applied to all patients presenting to three high volume Regional Stroke Prevention Clinics (combined first visits >2,800 patients per year). Data will be abstracted from the patient chart using methodologies developed and validated in the Registry of the Ontario Stroke Network. We have research ethics board approval to collect this data and to link with administrative data-sets through the Institute for Clinical and Evaluative Sciences (ICES). We will use regression models to determine whether DOC screen scores add to baseline clinical and demographic data to predict the main negative outcomes. We hope to identify which patients presenting to TIA/stroke prevention clinics are at highest risk of adverse long-term events so focused interventions can be developed to improve survival, outcomes and function of stroke prevention clinic patients.
The eligibility criteria were updated.
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Inclusion Criteria: - Attending outpatient TIA and Stroke Prevention Clinics at any of the three regional stroke centres. Exclusion Criteria: - Those who are unable to complete the screen complete the screen due to severe aphasia, severe motor dysfunction and those who are not fluent in English without translation available.
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Inclusion Criteria: - Attending outpatient TIA and Stroke Prevention Clinics at any of the three regional stroke centres. Exclusion Criteria: - Those who are admitted to LTC / CCC facilities at time of clinic visit will be excluded from the study.
A location was updated in Toronto.
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The overall status was removed for Sunnybrook Health Sciences Centre.