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made-in-canada tool to help save lives from stroke
about 10 per cent of people who suffer a transient ischemic attack have a full-blown stroke within a week.
the tool was conceived in 2006 by jeffrey perry, an emergency physician and senior scientist at the ottawa hospital.
the ottawa hospital
canadian doctors have developed a more effective way to determine which victims of a mini-stroke are most at risk of suffering a full-blown stroke, potentially saving hundreds of lives annually and sparing thousands more from a massive medical emergency.
the tool, known as the canadian tia score, was conceived in 2006 when jeffrey perry, an emergency physician and senior scientist at the ottawa hospital, became of aware of the alarming number of people who were being rushed back to hospitals shortly after suffering a transient ischemic attack. “we didn’t realize just how frequently patients with a tia or mini-stroke come back with a completed stroke,” perry told healthing.ca.
“ten per cent of the patients with this problem who presented to emergency came back with a completed stroke within 90 days. that was kind of startling to most clinicians because we didn’t realize that it was that common that people would deteriorate.”
a tia or mini-stroke occurs when there is a temporary blockage in the flow of blood to the brain causing a person to experience weakness in the arms or legs, a drooping face, loss of vision or difficulty speaking. the risk of having a subsequent, larger stroke is greatest in the first week following a tia. “we probably see about two patients a day at the ottawa hospital easily and it’s estimated that there’s probably at least 50,000 to 75,000 patients with tia diagnosed per year in canada.”
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knowing how much better patients who suffer from a mini-stroke fare with appropriate treatment, perry and his team developed the canadian tia, a clinical tool that relies on 13 data points assessed by emergency room doctors to determine the risk of another stroke. this data is used to group patients into three groups: high risk (patients with a 6 per cent risk of another stroke within the week), medium risk (2.3 per cent) and low risk (less than 0.5 per cent). the abcd2 test, another assessment tool currently in use, simply categorizes patients as either high or low risk, leaving less room for nuance between patients.
the canadian tia was confirmed effective over a five-year period of use in 13 emergency departments across canada. of the 7,607 patients in the program who suffered a tia, 17 per cent were deemed low risk of having an encore, 71 per cent were considered medium risk and 13 per cent were put in the high risk group. within the next week, 108 patients (1.4 per cent) had another stroke and 83 (1.1 per cent) were directed into surgery to improve blood flow to the brain. over a 90 day period, just 2.5 per cent of patients had another stroke, a far cry from the over 10 per cent that prompted the creation of the new tool in the first place.
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“we try to identify the really high-risk patients so that we can focus in on them to make sure they’re treated optimally right away,” perry said. “and the patients who weren’t at risk were managed and cared for in the appropriate way but wouldn’t necessarily need all the resources all at once when we’re already dealing with emergency department overcrowding and limited resources within the health care system.
“we want to make sure we can focus on the really high-risk patients to diminish their risk so that, overall, patients would certainly have much better outcomes.”
perry was confident the tool would be effective but said you never really know until it is tested in a real-world setting on a large number of patients. the hope now is to build on the tool’s success to further drop the rate of subsequent strokes. “so, we know we’re doing a much better job than we used to,” perry said. “but we also know that with optimal management we are probably able to get that subsequent stroke rate to 1 per cent or less at 90 days. “we’re hoping that the results of our study are going to further drive the subsequent stroke rates down to be as low as humanly possible.”
now it’s up to individual physicians and medical institutions to decide whether or not to adopt the new tool — which is available for free online and through the ottawa rules app. based on its effectiveness, perry did not seem too concerned.
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“it’s hard to say for sure but we certainly anticipate that this is probably going to save hundreds of lives within canada per year and if uptake is good in other countries it could certainly be thousands of patients per year,” he said. “i do expect there to be good adaptation internationally because there has been a lot of interest in the u.s.”
dave yasvinski is a writer with healthing.ca
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