Can lower risk patients presenting with transient ischaemic attack be safely managed as outpatients?

Griffiths, Dayna; Sturm, Jonathan; Heard, Robert; Reyneke, Elizabeth; Whyte, Scott; Clarke, Tracy; O’Brien, William F.; Crimmins, Dennis

doi:10.1016/j.jocn.2013.02.028

Cited by 8 publications

(19 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…On the other hand, systematic hospitalization of all TIA patients is economically inefficient [2], and may be problematic in terms of access to beds. As an alternative, the management of TIA patients in a dedicated same-day TIA clinic has been demonstrated to be both effective and safe [3][4][5]. However, despite these positive findings, such services remain very limited in France, and French guidelines for the management of TIA patients have not changed and still recommend hospitalization after TIA [6].…”

Section: Introductionmentioning

confidence: 99%

Factors associated with early recurrence at the first evaluation of patients with transient ischemic attack

Daubail

Durier

Jacquin

et al. 2014

Journal of Clinical Neuroscience

View full text Add to dashboard Cite

Section: Introductionmentioning

confidence: 99%

Factors associated with early recurrence at the first evaluation of patients with transient ischemic attack

Daubail

Durier

Jacquin

et al. 2014

Journal of Clinical Neuroscience

View full text Add to dashboard Cite

“…Six TIA risk stratification instruments have been evaluated in studies that met the inclusion criteria: ABCD, 9,11,13,[24][25][26][27][28][29][30] ABCD2, [6][7][8][9][10][11][12][13]17,26,27,[31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] ABCD3, 12,27,38 the California, 11,13,27,48 the Canadian TIA Score, 42 and the Essen Stroke Risk. 27 None of these instruments have been assessed in a Class I study.…”

Section: Criticalmentioning

confidence: 99%

“…The most frequently studied risk stratification instrument is the ABCD2 score (Appendix E). [6][7][8][9][10][11][12][13]17,26,27,[31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] The ABCD2 score was derived and validated using retrospective data from the California and Oxfordshire groups in a Class II 11 study. Using 1,916 patients with suspected TIA in the derivation group and 2,892 in the validation group, they noted a 3.9% and 7.5% frequency for stroke at 2 and 7 days, respectively.…”

Section: Criticalmentioning

confidence: 99%

“…Using a threshold of less than 4, the ABCD2 score identified 33.8% of patients as "low risk," with strokes occurring in 1% and 1.2% of these low-risk patients at 2 and 7 days, respectively. Since the derivation of the ABCD2 score, 6 Class II 34,40,42,44,45,47 and 21 Class III [6][7][8][9][10]12,13,17,26,27,[31][32][33][35][36][37][38][39]41,43,46 studies have evaluated this score. These studies varied from multi-institutional prospective studies to single-center retrospective ones.…”

Section: Criticalmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Policy: Critical Issues in the Evaluation of Adult Patients With Suspected Transient Ischemic Attack in the Emergency Department

Carpenter¹,

Wright²,

Brown³

et al. 2016

Annals of Emergency Medicine

View full text Add to dashboard Cite

This clinical policy from the American College of Emergency Physicians addresses key issues for adults presenting to the emergency department with suspected transient ischemic attack. A writing subcommittee conducted a systematic review of the literature to derive evidence-based recommendations to answer the following clinical questions: (1) In adult patients with suspected transient ischemic attack, are there clinical decision rules that can identify patients at very low short-term risk for stroke who can be safely discharged from the emergency department? (2) In adult patients with suspected transient ischemic attack, what imaging can be safely delayed from the initial emergency department workup? (3) In adult patients with suspected transient ischemic attack, is carotid ultrasonography as accurate as neck computed tomography angiography or magnetic resonance angiography in identifying severe carotid stenosis? (4) In adult patients with suspected transient ischemic attack, can a rapid emergency department-based diagnostic protocol safely identify patients at short-term risk for stroke? Evidence was graded and recommendations were made based on the strength of the available data.

show abstract

“…12 Unlike acute stroke management, controversy exists regarding whether all TIA patients require care as inpatients because neurological symptoms have resolved. 13 Many clinical and societal variables may contribute to the decision-making process regarding hospital admission 14 and some clinicians advocate admission of all TIA patients. 15 Rationale in support of universal hospital admission for TIA includes hospitalization allowing for timely evaluation, opportunity for intervention if a subsequent vascular event occurs, and rapid initiation of secondary prevention strategies.…”

Section: Introductionmentioning

confidence: 99%

Uncertainty as a Key Influence in the Decision To Admit Patients with Transient Ischemic Attack

et al. 2018

View full text Add to dashboard Cite

BACKGROUND: Patients with transient ischemic attacks (TIA) are at high risk of subsequent vascular events. Hospitalization improves quality of care, yet admission rates for TIA patients vary considerably. OBJECTIVES: We sought to identify factors associated with the decision to admit patents with TIA. DESIGN: We conducted a secondary analysis of a prior study's data including semi-structured interviews, administrative data, and chart review. PARTICIPANTS: We interviewed multidisciplinary clinical staff involved with TIA care. Administrative data included information for TIA patients in emergency departments or inpatient settings at VA medical centers (VAMCs) for fiscal years (FY) 2011 and 2014. Chart reviews were conducted on a subset of patients from 12 VAMCs in FY 2011. APPROACH: For the qualitative data, we focused on interviewees' responses to the prompt: "Tell me what influences you in the decision to or not to admit TIA patients." We used administrative data to identify admission rates and chart review data to identify ABCD 2 scores (a tool to classify stroke risk after TIA). KEY RESULTS: Providers' decisions to admit TIA patients were related to uncertainty in several domains: lack of a facility TIA-specific policy, inconsistent use of ABCD 2 score, and concerns about facilities' ability to complete a timely workup. There was a disconnect between staff perceptions about TIA admission and facility admission rates. According to chart review data, staff at facilities with higher admission rates in FY 2011 reported consistent reliance on ABCD 2 scores and related guidelines in admission decision-making. CONCLUSIONS:Many factors contributed to decisions regarding admitting a patient with TIA; however, clinicians' uncertainty appeared to be a key driver. Further quality improvement interventions for TIA care should focus on facility adoption of TIA protocols to address uncertainty in TIA admission decision-making and to standardize timely evaluation of TIA patients and delivery of secondary prevention strategies.KEY WORDS: transient ischemic attack; admission.

show abstract

Can lower risk patients presenting with transient ischaemic attack be safely managed as outpatients?

Cited by 8 publications

References 16 publications

Factors associated with early recurrence at the first evaluation of patients with transient ischemic attack

Factors associated with early recurrence at the first evaluation of patients with transient ischemic attack

Clinical Policy: Critical Issues in the Evaluation of Adult Patients With Suspected Transient Ischemic Attack in the Emergency Department

Uncertainty as a Key Influence in the Decision To Admit Patients with Transient Ischemic Attack

Contact Info

Product

Resources

About