Adjudication of Transient Ischemic Attack and Stroke in the Multi-Ethnic Study of Atherosclerosis

W. T. Longstreth, Natalie C. Gasca, Rebecca F Gottesman, John B. Pearce, Ralph L. Sacco

Research output: Contribution to journalArticle

Abstract

Background: To describe adjudication of transient ischemic attack (TIA) and stroke in an observational study. Methods: 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. Results: 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. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)23-28
Number of pages6
JournalNeuroepidemiology
DOIs
StateAccepted/In press - Jan 11 2018

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Transient Ischemic Attack
Atherosclerosis
Stroke
Research Personnel
Observational Studies
Blood Vessels
Longitudinal Studies
Cohort Studies

Keywords

  • Adjudication
  • Longitudinal study
  • Stroke
  • Transient ischemic attack

ASJC Scopus subject areas

  • Epidemiology
  • Clinical Neurology

Cite this

Adjudication of Transient Ischemic Attack and Stroke in the Multi-Ethnic Study of Atherosclerosis. / Longstreth, W. T.; Gasca, Natalie C.; Gottesman, Rebecca F; Pearce, John B.; Sacco, Ralph L.

In: Neuroepidemiology, 11.01.2018, p. 23-28.

Research output: Contribution to journalArticle

Longstreth, W. T. ; Gasca, Natalie C. ; Gottesman, Rebecca F ; Pearce, John B. ; Sacco, Ralph L. / Adjudication of Transient Ischemic Attack and Stroke in the Multi-Ethnic Study of Atherosclerosis. In: Neuroepidemiology. 2018 ; pp. 23-28.
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