Browsing by Author "Coutts, Shelagh B."

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    Final 2 year results of the vascular imaging of acute stroke for identifying predictors of clinical outcome and recurrent ischemic eveNts (VISION) study
    (BioMed Central, 2011-04-23) Coutts, Shelagh B.; Hill, Michael D.; Eliasziw, Misha; Fischer, Karyn; Demchuk, Andrew M.
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    Passive Surveillance of Transient Ischemic Attacks in the Emergency Department: Validity of Administrative Data and Determinants of Inaccuracies in Data Coding
    (2016) Yu, Amy Y. X.; Hill, Michael D.; Coutts, Shelagh B.; Quan, Hude; McRae, Andrew D.
    Stroke is a leading cause of morbidity and transient ischemic attacks (TIA) are an ideal target for stroke prevention strategies. Administrative data are an important source of information for TIA research, but they have not been validated in the emergency department (ED). We aimed to determine the validity of TIA codes in the Canadian ED administrative database and the predictors of accurate TIA coding. We studied patients presenting to the ED with acute neurological symptoms. The National Ambulatory Care Reporting System (NACRS) database diagnosis codes were compared to the ED chart re-abstraction and 90-day final clinical diagnoses to obtain the sensitivity, specificity, and predictive values. The sensitivity of TIA codes was low to moderate (37-64%), but the specificity was high (82-93%). Quality of physician documentation was an important predictor of data accuracy. Our findings inform TIA research and surveillance methods and we identify an opportunity for improving administrative data quality.
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    Whole-Brain Atrophy Rates, Regional Cerebral Blood Flow, and Cognitive Profiles of Transient Ischemic Attack Patients and Controls
    (2019-06-18) Reid, Meaghan; Barber, Philip A.; Sajobi, Tolulope T.; Coutts, Shelagh B.; Longman, Richard Stewart
    Dementia is one of the most common causes of disability amongst the old and the prevalence is expected to double within the next twenty years. Recent prevention trials have failed to find a cure, likely due to inappropriate trial selection and a lack of reliable outcome measurements. Standardized clinical, demographic, imaging and neuropsychological biomarkers will improve selection criteria and therapeutic interventions. Transient ischemic attack (TIA) patients are at an increased risk of late-life cognitive decline due to their common vascular risk factors with dementia and underlying cerebrovascular pathology. We hypothesized that TIA patients would have increased longitudinal rates of cerebral atrophy as measured by T1 magnetic resonance (MR) imaging compared to non-TIA controls over 1 year and that increased cerebral atrophy rates would be associated with poorer cognitive outcomes. Secondly, we hypothesized that at baseline TIA patients would have lower regional cerebral blood flow (CBF) as measured by arterial spin labelled (ASL) MR imaging compared to non-TIA controls, and that CBF would be associated with cognition. Our results suggest that TIA patients show almost double the cerebral atrophy rates of non-TIA controls over 1-year, and in the absence of demonstrated change in cognition, supports that these subjects with TIA are in a preclinical stage of cognitive decline. Our results also show that TIA patients have reduced CBF in the left entorhinal cortex, the posterior cingulate bilaterally and the right precuneus which was associated with poorer memory outcomes. These predictors of early neurodegeneration and vascular changes show that TIA patients are a high-risk population for dementia and could improve inclusion criteria for clinical trials to prevent dementia in the future.