Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jul;101(7):1243-1259.
doi: 10.1016/j.apmr.2019.12.013. Epub 2020 Jan 28.

Inconsistent Classification of Mild Stroke and Implications on Health Services Delivery

Pamela S Roberts  1 , Shilpa Krishnan  2 , Suzanne Perea Burns  3 , Debra Ouellette  4 , Monique R Pappadis  5
Affiliations

Inconsistent Classification of Mild Stroke and Implications on Health Services Delivery

Pamela S Roberts et al. Arch Phys Med Rehabil. 2020 Jul.

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.

Keywords: Health services research; Rehabilitation; Stroke.

PubMed Disclaimer

Figures

Figure 1:
Figure 1:
PRISMA Flowchart
See this image and copyright information in PMC

References

    1. Carlsson GE, Moller A, Blomstrand C. Managing an everyday life of uncertainty--a qualitative study of coping in persons with mild stroke. Disabil Rehabil. 2009;31(10):773–782. - PubMed
    1. Edwards JD, Kapral MK, Fang J, Swartz RH. Long-term morbidity and mortality in patients without early complications after stroke or transient ischemic attack. Cmaj. July 24 2017;189(29):E954–e961. - PMC - PubMed
    1. Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, San Roman L, Serena J, Abilleira S, Ribo M, Millan M, Urra X, Cardona P, Lopez-Cancio E, Tomasello A, Castano C, Blasco J, Aja L, Dorado L, Quesada H, Rubiera M, Hernandez-Perez M, Goyal M, Demchuk AM, von Kummer R, Gallofre M, Davalos A. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. June 11 2015;372(24) :2296–2306. - PubMed
    1. Messe SR, Khatri P, Reeves MJ, Smith EE, Saver JL, Bhatt DL, Grau-Sepulveda MV, Cox M, Peterson ED, Fonarow GC, Schwamm LH. Why are acute ischemic stroke patients not receiving IV tPA? Results from a national registry. Neurology. October 11 2016;87(15):1565–1574. - PMC - PubMed
    1. Hao Z, Liu M, Wang D, Wu B, Tao W, Chang X. Etiologic subtype predicts outcome in mild stroke: prospective data from a hospital stroke registry. BMC Neurol. October 24 2013;13:154. - PMC - PubMed

Publication types