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Appendix e-1. Search terms, PubMed, Embase, Medline database search strategy Search Terms

Accuracy Accurate Agree*

Diagnos*

Diagnostic accuracy Diagnostic error Interrater Inter?rater Interobserver Inter?observer Misdiagnos*

Reliab*

TIA Transient ischemic attack*

Transient Isch?emic attack*

Variab*

PubMed

Number Search Results

1 Search ((transient ischaemic attack) OR transient ischemic attack) OR TIA 20401 2 Search (((((transient ischaemic attack) OR transient ischemic attack) OR

TIA)) AND Diagnos*) OR misdiagnos* 42956

3 Search (((((((accurac*) OR agree*) OR reliab*) OR interrater*) OR inter-

rater*) OR interobserver*) OR inter-observer*) OR variab* 2047517 4 Search (((((transient ischaemic attack) OR transient ischemic attack) OR

TIA)) AND ((((((transient ischaemic attack) OR transient ischemic attack) OR TIA)) AND Diagnos*) OR misdiagnos*)) AND ((((((((accurac*) OR agree*) OR reliab*) OR interrater*) OR inter-rater*) OR interobserver*) OR inter-observer*) OR variab*)

1204

5 Search (((((((transient ischaemic attack) OR transient ischemic attack) OR TIA)) AND ((((((transient ischaemic attack) OR transient ischemic attack) OR TIA)) AND Diagnos*) OR misdiagnos*)) AND ((((((((accurac*) OR agree*) OR reliab*) OR interrater*) OR inter-rater*) OR interobserver*) OR inter-observer*) OR variab*))) AND English[Language]

1113

6 Search (((((((((transient ischaemic attack) OR transient ischemic attack) OR TIA)) AND ((((((transient ischaemic attack) OR transient ischemic attack) OR TIA)) AND Diagnos*) OR misdiagnos*)) AND

((((((((accurac*) OR agree*) OR reliab*) OR interrater*) OR inter-rater*) OR interobserver*) OR inter-observer*) OR variab*))) AND

English[Language])) AND ("1984"[Date - Publication] : "3000"[Date - Publication])

1079

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Embase

Number Search Results

1 transient ischemic attack/ 36429

2 "transient isch?emic attack*".mp. [mp=title, abstract, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword, floating subheading word, candidate term word]

40343

3 TIA.mp. [mp=title, abstract, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword, floating subheading word, candidate term word]

18111

4 1 or 2 or 3 48860

5 diagnosis/ or diagnostic accuracy/ or diagnostic

error/ 1596460

6 diagnos*.mp. [mp=title, abstract, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword, floating subheading word, candidate term word]

6125989

7 5 or 6 6125989

8 inter?observer*.mp. [mp=title, abstract, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword, floating subheading word, candidate term word]

22580

9 inter?rater*.mp. [mp=title, abstract, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword, floating subheading word, candidate term word]

20241

10 agree*.mp. [mp=title, abstract, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword, floating subheading word, candidate term word]

443449

11 misdiagnos*.mp. [mp=title, abstract, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword, floating subheading word, candidate term word]

45660

12 reliab*.mp. [mp=title, abstract, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword, floating subheading word, candidate term word]

620155

13 8 or 9 or 10 or 11 or 12 1069020

14 4 and 7 and 13 909

15 limit 14 to (human and english language and

yr="1984 -Current") 676

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Medline

Number Search Results

1 transient ischemic attack/ 20021

2 "transient isch?emic attack*".mp. [mp=title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]

13689

3 TIA.mp. [mp=title, abstract, original title, name of substance word, subject heading word, floating sub- heading word, keyword heading word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]

8139

4 1 or 2 or 3 30920

5 diagnosis/ or diagnostic accuracy/ or diagnostic

error/ 53895

6 diagnos*.mp. [mp=title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]

4833907

7 5 or 6 4833907

8 inter?observer*.mp. [mp=title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]

17442

9 inter?rater*.mp. [mp=title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]

8338

10 agree*.mp. [mp=title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]

368036

11 misdiagnos*.mp. [mp=title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]

31690

12 reliab*.mp. [mp=title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol

463638

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supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]

13 8 or 9 or 10 or 11 or 12 834498

14 4 and 7 and 13 601

15 limit 14 to (human and english language and

yr="1984 -Current") 436

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Appendix e-2. Vascular risk factors

Study, year Total number of patients

Number of

smokers Number of patients with hypertension

Number of patients with diabetes mellitus

Number of patients with atrial fibrillation

Benesch 1997 25 N/A N/A N/A N/A

Buchwald

2015 180 19 109 22 43

Chang 2016 13756 2586 9986 4126 2379

Ghia 2010 570 256 324 139 62

Hall 2016 773 N/A 362 180 121

Husseini 2011 100 N/A N/A N/A N/A

Karanjia 1997 381 N/A N/A N/A N/A

Koudstaal

1986 72 N/A N/A N/A N/A

Kraaijeveld

1994 56 N/A N/A N/A N/A

Krarup 2007 236 N/A N/A N/A N/A

Lasserson

2015 513 N/A N/A N/A N/A

Longstreth

2018 95 50 59 19 N/A

Oostema 2015 78 N/A N/A N/A N/A

Porter 2016 1575 N/A N/A N/A N/A

Sedova 2015a

+ b 99 N/A N/A N/A N/A

Sequeira 2016 285 N/A N/A N/A N/A

Van Rooij

2015 87 27 68 11 12

Wilson 2004a 142 N/A N/A N/A N/A

Wilson 2004b 99 N/A N/A N/A N/A

Wilson 2004c 136 N/A N/A N/A N/A

Yu 2017 163 N/A N/A N/A N/A

Total 19,421 2938/14688

(20.0%) 10908/15461

(70.6%) 4497/15461

(29.1%) 2617/15366

(17.0%)

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Appendix e-3. Guidelines for Reporting Reliability and Agreement Studies

Quality assessment of studies: n indicates no, y indicates yes

Study, year Subject population described Rater population described (e.g. training and experience) Measure of inter-rater variability described Time interval between measurements described Rating process described (e.g. availability of clinical information, blinding) State whether measurements/ratings were conducted independently Explains how the sample size was chosen, stating the determined number of raters, subjects, and replicate observations Total quality score (/7)

Benesch 1997 n y n n n n n 1

Buchwald

2015 y y y n y y y 6

Chang 2016 y y y n n y y 5

Ghia 2010 y y y n y y y 6

Hall 2016 y y n n n n n 2

Husseini 2011 y y y n y y y 6

Karanjia 1997 y y y n n n n 3

Koudstaal

1986 y y y y n y y 6

Kraaijeveld

1994 n n n y n n n 1

Krarup 2007 y y y n y y y 6

Lasserson

2015 y y y n n y y 5

Longstreth

2018 y y y n n n n 3

Oostema 2015 y n n y n y n 3

Porter 2016 y y y n y y y 6

Sedova 2015 y n y n n y y 4

Sequiera 2016 n n n n n n y 1

Van Rooij

2015 y y y y y y n 6

Wilson 2004 y y y n y y y 6

Yu 2017 y y y y n y y 6

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Appendix e-4. Evaluation of publication bias

Funnel plot of effect size (Cohen’s Kappa) by standard error across studies

Publication bias analysis

Egger’s linear regression test Intercept = -6.92 t = -8.17 (p < 0.05) Begg and Mazumdar’s rank

correlation test

Z-value for Kendall’s tau = 1.34 (p = 0.180)

Rosenthal’s fail safe N 823451602

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Appendix e-5. Effect of MRI access on TIA diagnostic agreement

There was no significant difference in diagnostic agreement between studies using

MRI and studies without MRI (p > 0.05).

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