Knowledge of TIA among general practitioners and emergency department physicians. A questionnaire survey in a French semi-rural area

Massengo, S.A.; Cisse, M.; Guiziou, C.; Leray, Emmanuelle; Rajabally, Yusuf A.; Edan, Gilles

doi:10.1016/j.clineuro.2013.01.026

Cited by 10 publications

(9 citation statements)

References 26 publications

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“…Özellikle sürekli nitelikte şiddetli baş dönmesi ve kusma şikayeti ile başvuran hastalara nöroloji konsültasyonu istenmesi gerektiği ve şiddetli baş ağrısıyla başvuran gebe hastalarda preeklampsi/eklampsi ve migren haricinde serebral ven trombozu da görülebileceği, bu nedenle dikkatli bir nörolojik muayene yapılması gerektiği akılda tutulmalıdır. Atipik prezentasyonlar ve geçici iskemik atak gibi serebrovasküler olaylar hakkında acil servis çalışanlarına ve aile hekimlerine yönelik eğitimler düzenlenmesi bu konuda önemli faydalar sağlayabilir (20,21).…”

Section: Discussionunclassified

Acute Stroke Through the Perspective of a County Hospital: Problems and Opportunities

Vural¹

2016

tnd

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Amaç: İnme dünya çapında en önemli halk sağlığı problemlerinden biri olup, ülkemizdeki mortalite sebepleri arasında ikinci sırada yer alır. İnme sonrası prognozun ve sağkalımın iyileştirilmesi amacıyla kullanılan en önemli yöntemlerden biri, ülkelerin kendi inme istatistiklerini düzenli olarak takip etmeleri ve eksik noktalarını tespit ederek gerekli önlemleri almalarıdır. Bunun için, sağlık hizmetlerinin çeşitli basamaklarında gerçekleştirilmiş istatistiksel çalışmalara ihtiyaç vardır. Bu tarz çalışmalar genellikle üçüncü basamak araştırma hastanelerinde gerçekleştirilebilmektedir. Nüfusun önemli bir kısmının tedavi edildiği ikinci basamaktaki durum ise bilinmemektedir. Bu çalışmanın amacı, bir ilçe hastanesine bir yıl boyunca başvuran tüm akut inmeli hastaları inceleyerek, konuyla ilgili veri sağlamak, eksiklikleri tartışmak ve çözüm önerileri sunmaktır. Gereç ve Yöntem: Temmuz 2013-Temmuz 2014 tarihleri arasında akut iskemik inme tanısı konulan tüm hastalar çalışmaya dahil edilmiştir. Hastaların demografik, klinik, radyolojik verileri ile başvuru süre ve Ulusal İnme Sağlık Ölçeği Skalası 'National Institutes of Health Stroke Scale' (NIHSS) skorları retrospektif olarak toplanmış, inme sınıflandırmaları yapılmıştır. Tüm hastalar inme sonrası en az bir yıl süreyle takip edilmiştir ve kümülatif sağkalım oranları Kaplan-Meier analiziyle hesaplanmıştır. Bulgular: Akut inme tanısı konulan 49 hastadan dördünde hemorajik inme saptanmış, iskemik inme tanısı alan 45 hasta çalışmaya dahil edilmiştir. Bu hastaların %44,4'ü (n=20) belirtilerin başlangıcını takiben ilk üç saatte, %4,4'ü (n=2) 3.-4,5. saatler arasında hastaneye başvurmuştur. İlk üç saatte başvuran hastaların %50'sinde (n=10) NIHSS 1-4 arası (hafif inme), diğer %50'sinde (n=10) NIHSS >=5 (orta veya ağır inme) tespit edilmiştir. Hastaların %37,1'inde (n=13) embolik, %20'sinde (n=7) büyük damar aterosklerozu, %8,6'sında (n=3) küçük damar hastalığı, %2,9'unda (n=1) arterial diseksiyon saptanırken, geri kalan %31,4'ünde (n=11) sebep bulunamamıştır. Hastaların 21'inde takipte ölüm (exitus) gelişmiştir. Bir, üç ve on iki aylık sağkalım oranları sırası ile %82,2, %57,8 ve %53,3 olarak hesaplanmıştır. Sonuç: Akut iskemik inmeli hastaların ikinci basamakta tedavisi üçüncü basamağa göre daha zor şartlarda gerçekleştirilmektedir. İnme sonrası prognozun ülke genelinde iyileştirilebilmesi için gelişmiş ülkelerdekine benzer önlemlerin ülkemiz şartlarına uyarlanarak uygulanması gerekmektedir. Anahtar Kelimeler: İnme, halk sağlığı, sağkalım Objective: Stroke is one of the most important public health issues worldwide, and ranks as the second highest cause of mortality in our country. Regular follow-up of stroke statistics and taking necessary precautions upon determining deficits by countries themselves constitute the most important way of improving prognosis and survival after stroke incidents. To achieve this goal, statistical studies should be performed at various levels of healthcare services. Tertiary care hospitals are the most suitable centers to perform these studies...

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Section: Discussionunclassified

Acute Stroke Through the Perspective of a County Hospital: Problems and Opportunities

Vural¹

2016

tnd

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“…Earlier studies found that a third of patients diagnosed with TIA in primary care clinics were not hospitalized and did not receive further tests or treatment [ 8 ]. Studies from Japan, France, Poland, Australia and the United States affirmed that most physicians are undereducated about the risk of stroke after TIA; many found it difficult to manage these patients [ 6 , 7 , 9 , 10 , 14 ]. It was not only primary care physicians who lacked knowledge; neurologists had the same problem [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Earlier surveys showed that primary care physicians found it hard to diagnose and manage TIAs, and that they treated TIA patients less urgently than stroke victims [ 6 – 10 ]; almost all of these studies were based on small samples. Recently, GPs and neurologists were the target of several articles in Swiss medical journals that described how to manage patients with TIAs [ 11 ][ 12 ][ 13 ] and the problem of estimating risk after TIA was commonly discussed at local, national and international conferences.…”

Section: Introductionmentioning

confidence: 99%

Awareness of Stroke Risk after TIA in Swiss General Practitioners and Hospital Physicians

et al. 2015

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BackgroundTransient ischemic attacks (TIA) are stroke warning signs and emergency situations, and, if immediately investigated, doctors can intervene to prevent strokes. Nevertheless, many patients delay going to the doctor, and doctors might delay urgently needed investigations and preventative treatments. We set out to determine how much general practitioners (GPs) and hospital physicians (HPs) knew about stroke risk after TIA, and to measure their referral rates.MethodsWe used a structured questionnaire to ask GPs and HPs in the catchment area of the University Hospital of Bern to estimate a patient’s risk of stroke after TIA. We also assessed their referral behavior. We then statistically analysed their reasons for deciding not to immediately refer patients.ResultsOf the 1545 physicians, 40% (614) returned the survey. Of these, 75% (457) overestimated stroke risk within 24 hours, and 40% (245) overestimated risk within 3 months after TIA. Only 9% (53) underestimated stroke risk within 24 hours and 26% (158) underestimated risk within 3 months; 78% (473) of physicians overestimated the amount that carotid endarterectomy reduces stroke risk; 93% (543) would rigorously investigate the cause of a TIA, but only 38% (229) would refer TIA patients for urgent investigations “very often”. Physicians most commonly gave these reasons for not making emergency referrals: patient’s advanced age; patient’s preference; patient was multimorbid; and, patient needed long-term care.ConclusionsAlthough physicians overestimate stroke risk after TIA, their rate of emergency referral is modest, mainly because they tend not to refer multimorbid and elderly patients at the appropriate rate. Since old and frail patients benefit from urgent investigations and treatment after TIA as much as younger patients, future educational campaigns should focus on the importance of emergency evaluations for all TIA patients.

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“…A study in Switzerland showed that knowledge of TIA was poor among general practitioners and hospital physicians, and only 38% referred patients for emergency assessment [29]. More than 40% of French general practitioners and emergency department physicians were unaware of the current TIA definition, and more than one third were unaware of the relevant national guidelines [30]. Clearly, improving awareness at many levels is a key factor in ensuring the timely delivery of optimal care in TIA.…”

Section: Leading Articlementioning

confidence: 99%

Transient Ischaemic Attacks: It’s time for timely action!

Mettananda

Ranawaka

2020

Ceylon Med. J.

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Knowledge of TIA among general practitioners and emergency department physicians. A questionnaire survey in a French semi-rural area

Cited by 10 publications

References 26 publications

Acute Stroke Through the Perspective of a County Hospital: Problems and Opportunities

Acute Stroke Through the Perspective of a County Hospital: Problems and Opportunities

Awareness of Stroke Risk after TIA in Swiss General Practitioners and Hospital Physicians

Transient Ischaemic Attacks: It’s time for timely action!

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