TY - JOUR
T1 - Influence of different screening procedures on the stroke prevalence estimates
T2 - The Italian Longitudinal Study on Aging
AU - Di Carlo, Antonio
AU - Candelise, Livia
AU - Gandolfo, Carlo
AU - Grigoletto, Francesco
AU - Volonnino, Giuseppina
AU - Baldereschi, Marzia
AU - Maggi, Stefania
AU - Scarlato, Guglielmo
AU - Amaducci, Luigi
AU - Inzitari, Domenico
AU - Battistin, Leontino
AU - Bressan, Marta
AU - Enzi, Giuliano
AU - Minicuci, Nadia
AU - Bortolan, Giovanni
AU - Canal, Nicola
AU - Franceschi, Massimo
AU - Scarpini, Elio
AU - Loeb, Carlo
AU - Ghetti, Augusto
AU - Vergassola, Rossano
AU - Bonaiuto, Salvatore
AU - Vesprini, Andrea
AU - Rengo, Franco
AU - Capurso, Antonio
AU - Livrea, Paolo
AU - Motta, Luciano
AU - Carnazzo, Giuseppe
PY - 1999/7
Y1 - 1999/7
N2 - Stroke prevalence surveys are more and more needed for health care and facility planning. Prevalence estimates and costs of the definition procedure may vary depending on different screening strategies. We evaluated the impact of these different strategies on the overall diagnostic procedure and on stroke prevalence estimates in the Italian Longitudinal Study on Aging. A population sample of 5632 individuals aged 65-84 years was screened for stroke by a simple question on previous stroke diagnosis, questions on possible stroke symptoms and a simple neurological examination. Those screened positive by any of these procedures were fully examined by a neurologist for conclusive diagnosis. We determined the positive predictive value of each procedure on the final stroke diagnosis and calculated prevalence as if each procedure had been used separately. Using the three procedures combined, the prevalence rate was 6.0% (95% confidence interval, 5.4-6.7%). If each procedure had been used as the unique screening tool, the rates would have been 5.1% (4.5-5.7%), 4.1% (3.6-4.7%) and 2.3% (1.9-2.7%), and positive predictive values 66.4, 55.2 and 45.1%, respectively. Different screening procedures can affect stroke prevalence estimates. Compared to more complex screening strategies, the use of a simple question about previous diagnosis as the unique screening tool leads to only a slight underestimation of stroke prevalence and avoids a 66% increase in the number of subjects to be examined in a second-level specialist evaluation, potentially reducing the costs of the overall diagnostic procedure.
AB - Stroke prevalence surveys are more and more needed for health care and facility planning. Prevalence estimates and costs of the definition procedure may vary depending on different screening strategies. We evaluated the impact of these different strategies on the overall diagnostic procedure and on stroke prevalence estimates in the Italian Longitudinal Study on Aging. A population sample of 5632 individuals aged 65-84 years was screened for stroke by a simple question on previous stroke diagnosis, questions on possible stroke symptoms and a simple neurological examination. Those screened positive by any of these procedures were fully examined by a neurologist for conclusive diagnosis. We determined the positive predictive value of each procedure on the final stroke diagnosis and calculated prevalence as if each procedure had been used separately. Using the three procedures combined, the prevalence rate was 6.0% (95% confidence interval, 5.4-6.7%). If each procedure had been used as the unique screening tool, the rates would have been 5.1% (4.5-5.7%), 4.1% (3.6-4.7%) and 2.3% (1.9-2.7%), and positive predictive values 66.4, 55.2 and 45.1%, respectively. Different screening procedures can affect stroke prevalence estimates. Compared to more complex screening strategies, the use of a simple question about previous diagnosis as the unique screening tool leads to only a slight underestimation of stroke prevalence and avoids a 66% increase in the number of subjects to be examined in a second-level specialist evaluation, potentially reducing the costs of the overall diagnostic procedure.
KW - Epidemiology
KW - Prevalence
KW - Screening questionnaires
KW - Stroke
UR - http://www.scopus.com/inward/record.url?scp=0033037636&partnerID=8YFLogxK
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U2 - 10.1159/000015961
DO - 10.1159/000015961
M3 - Article
C2 - 10393411
AN - SCOPUS:0033037636
VL - 9
SP - 231
EP - 237
JO - Cerebrovascular Diseases
JF - Cerebrovascular Diseases
SN - 1015-9770
IS - 4
ER -