Inconsistent Classification of Mild Stroke and Implications on Health Services Delivery

• Authors: Pamela S. Roberts, Cedars Sinai Medical Center California; Shilpa Krishnan, Emory University; Suzanne Burns, Texas Woman's University; Debra Ouellette, Casa Colina Hospital California; Monique R. Pappadis, University of Texas Galveston
• Journal Title: Archives of Physical Medicine and Rehabilitation
• Volume: Volume 101, Number 7
• Publisher: Elsevier | 2020-07-01, Pages 1243-1259
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.apmr.2019.12.013
• Subjects: Health Sciences, Rehabilitation and Therapy; Health Sciences, Health Care Management; Biology, Neuroscience
• Keywords: Science & Technology; Life Sciences & Biomedicine; Rehabilitation; Sport Sciences; Health services research; Stroke; Transient ischemic attack; Quality of life; Minor stroke; Plasminogen activator; Scientific statement; Functional outcomes; Care professionals; Early exercise; Participation; Severity

Abstract

Objective To conduct a scoping review on classifications of mild stroke based on stroke severity assessments and/or clinical signs and symptoms reported in the literature. Data Sources Electronic searches of PubMed, PsycINFO (Ovid), and Cumulative Index to Nursing and Allied Health (CINAHL–EBSCO) databases included keyword combinations of mild stroke, minor stroke, mini stroke, mild cerebrovascular, minor cerebrovascular, transient ischemic attack, or TIA. Study Selection Inclusion criteria were limited to articles published between January 2003 and February 2018. Inclusion criteria included studies (1) with a definition of either mild or minor stroke, (2) written in English, and (3) with participants aged 18 years and older. Animal studies, reviews, dissertations, blogs, editorials, commentaries, case reports, newsletters, drug trials, and presentation abstracts were excluded. Data Extraction Five reviewers independently screened titles and abstracts for inclusion and exclusion criteria. Two reviewers independently screened each full-text article for eligibility. The 5 reviewers checked the quality of the included full-text articles for accuracy. Data were extracted by 2 reviewers and verified by a third reviewer. Data Synthesis Sixty-two studies were included in the final review. Ten unique definitions of mild stroke using stroke severity assessments were discovered, and 10 different cutoff points were used. The National Institutes of Health Stroke Scale was the most widely used measure to classify stroke severity. Synthesis also revealed variations in classification of mild stroke across publication years, time since stroke, settings, and medical factors including imaging, medical indicators, and clinical signs and symptoms. Conclusions Inconsistencies in the classification of mild stroke are evident with varying use of stroke severity assessments, measurement cutoff scores, imaging tools, and clinical or functional outcomes. Continued work is necessary to develop a consensus definition of mild stroke, which directly affects treatment receipt, referral for services, and health service delivery.