NEW ORLEANS – A brief online evaluation may prompt patients to seek quick medical attention if they experience symptoms of stroke or transient ischemic attack.
Researchers are evaluating the WebTIA Program, a 26-item questionnaire that identifies risk factors and symptoms common to stroke and TIA. The investigative deployment has enrolled more than 251 people from across the country, who came upon WebTIA when searching for information on symptoms, Dr. Anthony Kim said at an international stroke conference.
(www.tia.ucsf.edu)
Researchers are evaluating the WebTIA Program, a 26-item questionnaire that identifies risk factors and symptoms common to stroke and TIA.
Immediate medical attention offers the best outcomes for patients, said Dr. Kim, medical director of the University of California, San Francisco, Stroke Center. But because TIA symptoms can come and go suddenly, they may not be enough to prompt a patient to visit to the emergency department, or even a call to the physician.
"There is a perception that because the symptoms resolved or improved, they are not as serious," he said at the meeting, sponsored by the American Stroke Association. "Even when the symptoms are correctly recognized as a TIA or stroke, people tend to underappreciate the need for urgent evaluation."
The Internet could improve this understanding, because it’s available 24 hours a day and there are no barriers to access, as there can be with a doctor’s or emergency department visit.
The ongoing WebTIA survey aims to test the utility of the Internet as a resource for helping people identify serious cerebrovascular symptoms. The survey page comes up as an option when people search for key words or phrases, such as "Am I having a ministroke." A click-through ad also appears on some other sites with stroke information.
The WebTIA site includes videos and text explanations of the TIA and stroke, and describes how taking the survey helps researchers create an effective Web-based risk-evaluation tool. The step-by-step program begins with six qualification questions and then guides visitors through the process of informed consent and explains Internet privacy terms. If patients agree, they answer a 26-item questionnaire that incorporates the ABCD2 score, as well as questions that give some hint about the brain territory affected. If visitors indicate that symptoms are occurring at the moment, the survey urges them to stop reading and seek emergency help.
The concluding page gives visitors the option to contact a study neurologist immediately, by phone or by computer, and reminds them that they’ll get a follow-up call from a neurologist participating in the study.
In the first 3 months, the WebTIA site received an average of 200 hits per day. More than 250 people completed the online interview; there were 175 follow-up interviews. The mean age was 59 years; the oldest visitor was aged 88 years, showing that elderly people can easily use the Internet to access information.
About two-thirds of the visitors had sought medical advice for their symptoms. Many noted that their symptoms had occurred within the prior 30 minutes and subsided. One man, vacationing in a recreational vehicle, completed the survey from his phone. About a quarter of visitors were sent to the hospital within minutes, hours, or a day.
Follow-up interviews determined that 43 (25%) had suffered a TIA and that 67 (39%) had either a TIA or a stroke. "There was good agreement between the online tool and our neurologists’ assessment," Dr. Kim remarked.
The ABCD2 score itself, however, was only moderately predictive, with a discrimination rate of 69%. "One of the 12 patients with a risk score of 0 had a cerebrovascular event of isolated diplopia," Dr. Kim said. Incorporating a question about diplopia and one about prior TIA or stroke improved the discrimination rate to 78%. By this calculation, seven patients had a risk score of 0, and none of those had an event.
"We identified a population of patients with possible TIA or stroke that might be a promising target for a computer-based public health intervention that could reduce delays to medical intervention." Such interventions would involve minimal cost and have the potential to reach a very large population, Dr. Kim said.
The project was funded by a grant from the National Stroke Association and Boehringer Ingelheim. Dr. Kim said he received a research grant from the company.