{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T03:41:52Z","timestamp":1767843712554,"version":"3.49.0"},"reference-count":46,"publisher":"Royal College of General Practitioners","issue":"665","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J Gen Pract"],"published-print":{"date-parts":[[2017,12]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Over 150 000 cases of suspected transient ischaemic attack (TIA) are referred to outpatient clinics in England each year. The majority of referrals are made by GPs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>This study aimed to identify how many patients referred to a TIA clinic actually have TIA (that is, calculate the positive predictive value [PPV] of first-contact healthcare referral) and to record the alternative diagnoses in patients without TIA, in order to determine the optimal service model for patients with suspected TIA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design and setting<\/jats:title><jats:p>A systematic review of TIA clinic referrals from first-contact health professionals (GPs and emergency department [ED] doctors) was undertaken.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Four databases were searched using terms for TIA and diagnostic accuracy. Data on the number of patients referred to a TIA clinic who actually had a TIA (PPVs) were extracted. Frequencies of differential diagnoses were recorded, where reported. Study quality was assessed using the QUADAS-2 tool.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Nineteen studies were included and reported sufficient information on referrals from GPs and ED doctors to derive PPVs (<jats:italic>n<\/jats:italic> = 15 935 referrals). PPVs for TIA ranged from 12.9% to 72.5%. A formal meta-analysis was not conducted due to heterogeneity across studies. Of those not diagnosed with TIA, approximately half of the final diagnoses were of neurological or cardiovascular conditions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study highlights the variation in prevalence of true vascular events in patients referred to TIA clinics. For patients without a cerebrovascular diagnosis, the high prevalence of conditions that also require specialist investigations and management are an additional burden on a care pathway that is primarily designed to prevent recurrent stroke. Service commissioners need to assess whether the existing outpatient provision is optimal for people with pathologies other than cerebrovascular disease.<\/jats:p><\/jats:sec>","DOI":"10.3399\/bjgp17x693677","type":"journal-article","created":{"date-parts":[[2017,11,21]],"date-time":"2017-11-21T01:40:21Z","timestamp":1511228421000},"page":"e871-e880","source":"Crossref","is-referenced-by-count":8,"title":["Predictive values of referrals for transient ischaemic attack from first-contact health care: a systematic review"],"prefix":"10.3399","volume":"67","author":[{"given":"Rebecca","family":"Kandiyali","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel S","family":"Lasserson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Penny","family":"Whiting","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alison","family":"Richards","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Mant","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1987","published-online":{"date-parts":[[2017,11,20]]},"reference":[{"key":"2020081209310345000_67.665.e871.1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.108.192218"},{"key":"2020081209310345000_67.665.e871.2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.32.5.1085"},{"key":"2020081209310345000_67.665.e871.3","doi-asserted-by":"publisher","DOI":"10.1258\/rsmsmj.52.1.4"},{"key":"2020081209310345000_67.665.e871.4","doi-asserted-by":"publisher","DOI":"10.4997\/JRCPE.2013.205"},{"key":"2020081209310345000_67.665.e871.5","doi-asserted-by":"publisher","DOI":"10.1001\/jama.298.24.2877"},{"key":"2020081209310345000_67.665.e871.6","unstructured":"Mant J Ryan R McManus R (2008) What is the optimum model of service delivery for transient ischaemic attack? 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