Systolic blood pressure as a predictor of transient ischemic attack/minor stroke in emergency department patients under age 80: a prospective cohort study
| dc.contributor.author | Penn, Andrew M. | |
| dc.contributor.author | Croteau, Nicole Samantha | |
| dc.contributor.author | Votova, Kristine | |
| dc.contributor.author | Sedgwick, Colin | |
| dc.contributor.author | Balshaw, Robert | |
| dc.contributor.author | Coutts, Shelagh B. | |
| dc.contributor.author | Penn, Melanie | |
| dc.contributor.author | Blackwood, Kaitlin | |
| dc.contributor.author | Bibok, Maximilian B. | |
| dc.contributor.author | Saly, Viera | |
| dc.contributor.author | Hegedus, Janka | |
| dc.contributor.author | Yu, Amy Y. X. | |
| dc.contributor.author | Zerna, Charlotte | |
| dc.contributor.author | Klourfeld, Evgenia | |
| dc.contributor.author | Lesperance, Mary L. | |
| dc.date.accessioned | 2020-11-17T17:58:31Z | |
| dc.date.available | 2020-11-17T17:58:31Z | |
| dc.date.copyright | 2019 | en_US |
| dc.date.issued | 2019 | |
| dc.description.abstract | Background Elevated blood pressure (BP) at emergency department (ED) presentation and advancing age have been associated with risk of ischemic stroke; however, the relationship between BP, age, and transient ischemic attack/minor stroke (TIA/MS) is not clear. Methods A multi-site, prospective, observational study of 1084 ED patients screened for suspected TIA/MS (symptom onset < 24 h, NIHSS< 4) between December 2013 and April 2016. Systolic and diastolic BP measurements (SBP, DBP) were taken at ED presentation. Final diagnosis was consensus adjudication by stroke neurologists; patients were diagnosed as either TIA/MS or stroke-mimic (non-cerebrovascular conditions). Conditional inference trees were used to define age cut-points for predicting binary diagnosis (TIA/MS or stroke-mimic). Logistic regression models were used to estimate the effect of BP, age, sex, and the age-BP interaction on predicting TIA/MS diagnosis. Results Over a 28-month period, 768 (71%) patients were diagnosed with TIA/MS: these patients were older (mean 71.6 years) and more likely to be male (58%) than stroke-mimics (61.4 years, 41%; each p < 0.001). TIA/MS patients had higher SBP than stroke-mimics (p < 0.001). DBP did not differ between the two groups (p = 0.191). SBP was predictive of TIA/MS diagnosis in younger patients, after accounting for age and sex; an increase of 10 mmHg systolic increased the odds of TIA/MS 18% (odds ratio [OR] 1.18, 95% CI 1.00–1.39) in patients < 60 years, and 23% (OR 1.23, 95% CI 11.12–1.35) in those 60–79 years, while not affecting the odds of TIA/MS in patients ≥80 years (OR 0.99, 95% CI 0.89–1.07). Conclusions Raised SBP in patients younger than 80 with suspected TIA/MS may be a useful clinical indicator upon initial presentation to help increase clinicians’ suspicion of TIA/MS. | en_US |
| dc.description.reviewstatus | Reviewed | en_US |
| dc.description.scholarlevel | Faculty | en_US |
| dc.description.sponsorship | This work was supported by Genome British Columbia, Genome Alberta, and Genome Canada (grant number TIA 4125-Penn). The funding bodies had no role in the design of the study or the collection, analysis, interpretation of data or in the writing of this manuscript. | en_US |
| dc.identifier.uri | https://doi.org/10.1186/s12883-019-1466-4 | |
| dc.identifier.uri | http://hdl.handle.net/1828/12358 | |
| dc.language.iso | en | en_US |
| dc.publisher | BMC Neurology | en_US |
| dc.relation.ispartofseries | Penn, A. M., Croteau, N. S., Votova, K., Sedgwick, C., Balshaw, R. F., Coutts, S. B., … Lesperance, M. L. (2019). Systolic blood pressure as a predictor of transient ischemic attack/minor stroke in emergency department patients under age 80: a prospective cohort study. BMC Neurology, 19(1). https://doi.org/10.1186/s12883-019-1466-4 | en_US |
| dc.subject | Transient ischemic attack | en_US |
| dc.subject | TIA | en_US |
| dc.subject | Minor stroke | en_US |
| dc.subject | Blood pressure | en_US |
| dc.subject | Emergency medicine | en_US |
| dc.title | Systolic blood pressure as a predictor of transient ischemic attack/minor stroke in emergency department patients under age 80: a prospective cohort study | en_US |
| dc.type | Article | en_US |