Inconsistent Classification of Mild Stroke and Implications of Health Services Delivery

Abstract Objective To conduct a scoping review of mild stroke definitions based on stroke severity assessments and/or clinical signs and symptoms reported in the literature. Data Sources Electronic searches of PubMed, PsycINFO (Ovid), and 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 (1) a definition of either mild or minor stroke, (2) written in English, (3) 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 five reviewers checked the quality of the included full-text articles for accuracy. Data were extracted by two 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 ten different cutoff points were used with the most widely used measure to classify stroke severity – the National Institutes of Health Stroke Scale (NIHSS). Synthesis also revealed variations in stroke severity across years, time since stroke, imaging, medical indicators, clinical signs and symptoms and settings. Conclusions Inconsistencies in the classification of mild stroke are evident with varying use of stroke severity assessments, measurement cut-off scores, imaging tools, and clinical or functional outcomes. Continued work is necessary to develop a consensus definition of mild stroke, which directly impacts treatment receipt, referral for services, and health service delivery.