Referral pathways for patients with TIA avoiding hospital admission: a scoping review

Abstract

ObjectiveTo identify the features and effects of a pathway for emergency assessment and referral of patients with suspected transient ischaemic attack (TIA) in order to avoid admission to hospital.DesignScoping review.Data sourcesPubMed, CINAHL Web of Science, Scopus.Study selectionReports of primary research on referral of patients with suspected TIA directly to specialist outpatient services.Data extractionWe screened studies for eligibility and extracted data from relevant studies. Data were analysed to describe setting, assessment and referral processes, treatment, implementation and outcomes.Results8 international studies were identified, mostly cohort designs. 4 pathways were used by family doctors and 3 pathways by emergency department physicians. No pathways used by paramedics were found. Referrals were made to specialist clinic either directly or via a 24-hour helpline. Practitioners identified TIA symptoms and risk of further events using a checklist including the ABCD2 tool or clinical assessment. Antiplatelet medication was often given, usually aspirin unless contraindicated. Some patients underwent tests before referral and discharge. 5 studies reported reduced incident of stroke at 90 days, from 6–10% predicted rate to 1.3–2.1% actual rate. Between 44% and 83% of suspected TIA cases in these studies were referred through the pathways.ConclusionsResearch literature has focused on assessment and referral by family doctors and ED physicians to reduce hospitalisation of patients with TIA. No pathways for paramedical use were reported. We will use results of this scoping review to inform development of a paramedical referral pathway to be tested in a feasibility trial.Trial registration numberISRCTN85516498. Stage: pre-results.

ED Referral Dramatically Reduces Delays of Initial Evaluation in a French TIA Clinic

“…Two types of medical referral can be distinguished:( 10 ). The first type is Office Based Physician (OBP) referral: The first TIA clinics created in Paris and Oxford were dedicated to accommodating primary care physicians (PCP) to refer TIA patients via a toll free number ( 5 , 6 ).…”

Prediction of stroke risk in patients with transient ischemic attack: ABCD score and its derived scores

“…Results showed that high ABCD score indicates high incidence of stroke within 30 d. ABCD score reached 0-2, 3, 4, 5, and 6 with risks of stroke reaching 0%, 3.5%, 7.6%, 21.3% and 31.3% respectively; at the same time, ABCD score of 5-6 points within 30 d stroke risk is eight times higher than that of ABCD score of 4 points or less. 8,9 The study suggests good clinical use of this score to predict reliability of the risk of stroke after TIA. ABCD score can identify high risk of stroke patients at an early period.…”

“…2,8,9,11,22 In 2010, researchers established ABCD3 and ABCD3I score. 15 Which on the basis of the ABCD2 added an index in ABCD3: double TIA (TIA attack 2 times or more within 7 days, 2points), the total score nine points; ABCD3I score increased three indicators (double TIA, ipsilateral carotid stenosis, positive DWI), a total of eight items: age 60 years or more (1 point), blood pressure >140/90 MMHG (1 point), clinical symptoms (words damaged 1 points; partial side limb weakness 2 points), duration of symptoms (10-59 minutes 1point; 2 minutes and 60 minutes or higher), diabetes (1 point), double TIA, carotid stenosis and positive DWI (2 points), and all score of 13 points.…”