Evidence map›Paper›PMID 25477216›Full record

ArticleStroke2015

Computed tomography identifies patients at high risk for stroke after transient ischemic attack/nondisabling stroke: prospective, multicenter cohort study.

Jason K Wasserman, Jeffrey J Perry, Marco L A Sivilotti, Jane Sutherland, Andrew Worster, Marcel Émond, Albert Y Jin, Wieslaw J Oczkowski, Demetrios J Sahlas, Heather Murray and 7 more

Open access · bronzeAbstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in Stroke, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.

0numbers the graph read from it
0cells of the map it votes in
14citing papers in PubMed
1.3field-weighted citation impact, top 21% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

14 citing papers in PubMed, 26 citations in OpenAlex.

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  8. Transient ischemic attack and minor stroke: diagnosis, risk stratification and management.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2022
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

17 authors at 4 institutions in 1 country.

Jason K WassermanFrom the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.), Queen's University, Kingston, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (J.S.); Division of Emergency Medicine (A.W.), Division of Neurology (W.J.O., D.J.S.), and Population Health Research Institute (M.S.), Department of Neurology, McMaster University, Hamilton, Ontario, Canada; Department of Emergency Medicine, Université Laval, Quebec, Quebec, Canada (M.É.); and Department of Neurology, Hôpital de l'Enfant-Jesus, Quebec City, Quebec, Canada (A.M., S.V.).
Jeffrey J PerryFrom the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.), Queen's University, Kingston, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (J.S.); Division of Emergency Medicine (A.W.), Division of Neurology (W.J.O., D.J.S.), and Population Health Research Institute (M.S.), Department of Neurology, McMaster University, Hamilton, Ontario, Canada; Department of Emergency Medicine, Université Laval, Quebec, Quebec, Canada (M.É.); and Department of Neurology, Hôpital de l'Enfant-Jesus, Quebec City, Quebec, Canada (A.M., S.V.). jperry@ohri.ca.
Marco L A SivilottiFrom the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.), Queen's University, Kingston, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (J.S.); Division of Emergency Medicine (A.W.), Division of Neurology (W.J.O., D.J.S.), and Population Health Research Institute (M.S.), Department of Neurology, McMaster University, Hamilton, Ontario, Canada; Department of Emergency Medicine, Université Laval, Quebec, Quebec, Canada (M.É.); and Department of Neurology, Hôpital de l'Enfant-Jesus, Quebec City, Quebec, Canada (A.M., S.V.).
Jane SutherlandFrom the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.), Queen's University, Kingston, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (J.S.); Division of Emergency Medicine (A.W.), Division of Neurology (W.J.O., D.J.S.), and Population Health Research Institute (M.S.), Department of Neurology, McMaster University, Hamilton, Ontario, Canada; Department of Emergency Medicine, Université Laval, Quebec, Quebec, Canada (M.É.); and Department of Neurology, Hôpital de l'Enfant-Jesus, Quebec City, Quebec, Canada (A.M., S.V.).
Andrew WorsterFrom the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.), Queen's University, Kingston, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (J.S.); Division of Emergency Medicine (A.W.), Division of Neurology (W.J.O., D.J.S.), and Population Health Research Institute (M.S.), Department of Neurology, McMaster University, Hamilton, Ontario, Canada; Department of Emergency Medicine, Université Laval, Quebec, Quebec, Canada (M.É.); and Department of Neurology, Hôpital de l'Enfant-Jesus, Quebec City, Quebec, Canada (A.M., S.V.).
Marcel ÉmondFrom the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.), Queen's University, Kingston, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (J.S.); Division of Emergency Medicine (A.W.), Division of Neurology (W.J.O., D.J.S.), and Population Health Research Institute (M.S.), Department of Neurology, McMaster University, Hamilton, Ontario, Canada; Department of Emergency Medicine, Université Laval, Quebec, Quebec, Canada (M.É.); and Department of Neurology, Hôpital de l'Enfant-Jesus, Quebec City, Quebec, Canada (A.M., S.V.).
Albert Y JinFrom the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.), Queen's University, Kingston, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (J.S.); Division of Emergency Medicine (A.W.), Division of Neurology (W.J.O., D.J.S.), and Population Health Research Institute (M.S.), Department of Neurology, McMaster University, Hamilton, Ontario, Canada; Department of Emergency Medicine, Université Laval, Quebec, Quebec, Canada (M.É.); and Department of Neurology, Hôpital de l'Enfant-Jesus, Quebec City, Quebec, Canada (A.M., S.V.).
Wieslaw J OczkowskiFrom the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.), Queen's University, Kingston, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (J.S.); Division of Emergency Medicine (A.W.), Division of Neurology (W.J.O., D.J.S.), and Population Health Research Institute (M.S.), Department of Neurology, McMaster University, Hamilton, Ontario, Canada; Department of Emergency Medicine, Université Laval, Quebec, Quebec, Canada (M.É.); and Department of Neurology, Hôpital de l'Enfant-Jesus, Quebec City, Quebec, Canada (A.M., S.V.).
Demetrios J SahlasFrom the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.), Queen's University, Kingston, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (J.S.); Division of Emergency Medicine (A.W.), Division of Neurology (W.J.O., D.J.S.), and Population Health Research Institute (M.S.), Department of Neurology, McMaster University, Hamilton, Ontario, Canada; Department of Emergency Medicine, Université Laval, Quebec, Quebec, Canada (M.É.); and Department of Neurology, Hôpital de l'Enfant-Jesus, Quebec City, Quebec, Canada (A.M., S.V.).
Heather MurrayFrom the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.), Queen's University, Kingston, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (J.S.); Division of Emergency Medicine (A.W.), Division of Neurology (W.J.O., D.J.S.), and Population Health Research Institute (M.S.), Department of Neurology, McMaster University, Hamilton, Ontario, Canada; Department of Emergency Medicine, Université Laval, Quebec, Quebec, Canada (M.É.); and Department of Neurology, Hôpital de l'Enfant-Jesus, Quebec City, Quebec, Canada (A.M., S.V.).
Ariane MacKeyFrom the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.), Queen's University, Kingston, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (J.S.); Division of Emergency Medicine (A.W.), Division of Neurology (W.J.O., D.J.S.), and Population Health Research Institute (M.S.), Department of Neurology, McMaster University, Hamilton, Ontario, Canada; Department of Emergency Medicine, Université Laval, Quebec, Quebec, Canada (M.É.); and Department of Neurology, Hôpital de l'Enfant-Jesus, Quebec City, Quebec, Canada (A.M., S.V.).
Steve VerreaultFrom the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.), Queen's University, Kingston, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (J.S.); Division of Emergency Medicine (A.W.), Division of Neurology (W.J.O., D.J.S.), and Population Health Research Institute (M.S.), Department of Neurology, McMaster University, Hamilton, Ontario, Canada; Department of Emergency Medicine, Université Laval, Quebec, Quebec, Canada (M.É.); and Department of Neurology, Hôpital de l'Enfant-Jesus, Quebec City, Quebec, Canada (A.M., S.V.).
George A WellsFrom the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.), Queen's University, Kingston, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (J.S.); Division of Emergency Medicine (A.W.), Division of Neurology (W.J.O., D.J.S.), and Population Health Research Institute (M.S.), Department of Neurology, McMaster University, Hamilton, Ontario, Canada; Department of Emergency Medicine, Université Laval, Quebec, Quebec, Canada (M.É.); and Department of Neurology, Hôpital de l'Enfant-Jesus, Quebec City, Quebec, Canada (A.M., S.V.).
Dar DowlatshahiFrom the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.), Queen's University, Kingston, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (J.S.); Division of Emergency Medicine (A.W.), Division of Neurology (W.J.O., D.J.S.), and Population Health Research Institute (M.S.), Department of Neurology, McMaster University, Hamilton, Ontario, Canada; Department of Emergency Medicine, Université Laval, Quebec, Quebec, Canada (M.É.); and Department of Neurology, Hôpital de l'Enfant-Jesus, Quebec City, Quebec, Canada (A.M., S.V.).
Grant StottsFrom the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.), Queen's University, Kingston, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (J.S.); Division of Emergency Medicine (A.W.), Division of Neurology (W.J.O., D.J.S.), and Population Health Research Institute (M.S.), Department of Neurology, McMaster University, Hamilton, Ontario, Canada; Department of Emergency Medicine, Université Laval, Quebec, Quebec, Canada (M.É.); and Department of Neurology, Hôpital de l'Enfant-Jesus, Quebec City, Quebec, Canada (A.M., S.V.).
Ian G StiellFrom the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.), Queen's University, Kingston, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (J.S.); Division of Emergency Medicine (A.W.), Division of Neurology (W.J.O., D.J.S.), and Population Health Research Institute (M.S.), Department of Neurology, McMaster University, Hamilton, Ontario, Canada; Department of Emergency Medicine, Université Laval, Quebec, Quebec, Canada (M.É.); and Department of Neurology, Hôpital de l'Enfant-Jesus, Quebec City, Quebec, Canada (A.M., S.V.).
Mukul SharmaFrom the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.), Queen's University, Kingston, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (J.S.); Division of Emergency Medicine (A.W.), Division of Neurology (W.J.O., D.J.S.), and Population Health Research Institute (M.S.), Department of Neurology, McMaster University, Hamilton, Ontario, Canada; Department of Emergency Medicine, Université Laval, Quebec, Quebec, Canada (M.É.); and Department of Neurology, Hôpital de l'Enfant-Jesus, Quebec City, Quebec, Canada (A.M., S.V.).
McMaster University · CAOttawa Hospital Research InstitutePopulation Health Research Institute · CAOttawa Hospital · CA

Funding

Canadian Institutes of Health Research 172524
6 · The paper itself

Abstract

background and purposeIschemia on computed tomography (CT) is associated with subsequent stroke after transient ischemic attack. This study assessed CT findings of acute ischemia, chronic ischemia, or microangiopathy for predicting subsequent stroke after transient ischemic attack.

methodsThis prospective cohort study enrolled patients with transient ischemic attack or nondisabling stroke that had CT scanning within 24 hours. Primary outcome was subsequent stroke within 90 days. Secondary outcomes were stroke at ≤2 or >2 days. CT findings were classified as ischemia present or absent and acute or chronic or microangiopathy. Analysis used Fisher exact test and multivariate logistic regression.

resultsA total of 2028 patients were included; 814 had ischemic changes on CT. Subsequent stroke rate was 3.4% at 90 days and 1.5% at ≤2 days. Stroke risk was greater if baseline CT showed acute ischemia alone (10.6%; P=0.002), acute+chronic ischemia (17.4%; P=0.007), acute ischemia+microangiopathy (17.6%; P=0.019), or acute+chronic ischemia+microangiopathy (25.0%; P=0.029). Logistic regression found acute ischemia alone (odds ratio [OR], 2.61; 95% confidence interval [CI[, 1.22-5.57), acute+chronic ischemia (OR, 5.35; 95% CI, 1.71-16.70), acute ischemia+microangiopathy (OR, 4.90; 95% CI, 1.33-18.07), or acute+chronic ischemia+microangiopathy (OR, 8.04; 95% CI, 1.52-42.63) was associated with a greater risk at 90 days, whereas acute+chronic ischemia (OR, 10.78; 95% CI, 2.93-36.68), acute ischemia+microangiopathy (OR, 8.90; 95% CI, 1.90-41.60), and acute+chronic ischemia+microangiopathy (OR, 23.66; 95% CI, 4.34-129.03) had greater risk at ≤2 days. Only acute ischemia (OR, 2.70; 95% CI, 1.01-7.18; P=0.047) was associated with a greater risk at >2 days.

conclusionsIn patients with transient ischemic attack/nondisabling stroke, CT evidence of acute ischemia alone or acute ischemia with chronic ischemia or microangiopathy was associated with increased subsequent stroke risk within 90 days.

Indexed as

AgedAged, 80 and overBrainBrain IschemiaCerebral Small Vessel DiseasesChronic DiseaseFemaleHumansIschemic Attack, TransientMaleMiddle AgedRecurrenceRisk AssessmentStatistics as TopicStrokeTomography, X-Ray Computedbrain infarctionstroketomography scanners, x-ray, computedtransient ischemic attack

Identifiers

PMID25477216
OpenAlexW1999063619

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