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Emergency physicians’ management of transient ischemic attack and desired sensitivity of a clinical decision rule for stroke in three countries

Published online by Cambridge University Press:  11 May 2015

Jeffrey J. Perry ,
Reena Goindi ,
Jamie Brehaut ,
Monica Taljaard ,
Sandra Schneider  and
Ian G. Stiell
Jeffrey J. Perry*
Affiliation:
Department of Emergency Medicine, Department of Epidemiology and Community Medicine, Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
Reena Goindi
Affiliation:
Department of Emergency Medicine, Department of Epidemiology and Community Medicine, Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
Jamie Brehaut
Affiliation:
Department of Emergency Medicine, Department of Epidemiology and Community Medicine, Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
Monica Taljaard
Affiliation:
Department of Emergency Medicine, Department of Epidemiology and Community Medicine, Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
Sandra Schneider
Affiliation:
Department of Emergency Medicine, University of Rochester, Rochester, NY
Ian G. Stiell
Affiliation:
Department of Emergency Medicine, Department of Epidemiology and Community Medicine, Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
*
Clinical Epidemiology Unit, F6, Ottawa Hospital Research Institute, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, ON K1Y 4E9; [email protected]

Abstract

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Objective:

Four to 10% of patients with transient ischemic attack (TIA) suffer a stroke or die within 7 days. Our objectives were to determine (1) current practice for investigating and treating emergency department (ED) patients with TIA, (2) willingness to use a clinical decision rule to identify patients at high risk of impending stroke or death, and (3) the required sensitivity of this rule.

Methods:

We administered a mail survey to a random sample of members of three national emergency physician associations in Australia, Canada, and the United States using a modified Dillman technique. A prenotification letter and up to three surveys were sent.

Results:

A total of 801 responses (53.7%) from 1,493 surveys were received; 53.6% (95% CI 47.5–59.7) of emergency physicians reported routinely admitting TIA patients, ranging from 6.6% in Canada to 56.7% in the United States, and 9.9% of emergency physicians have a stroke prevention clinic, with 4.7% estimating that patients are seen within 7 days. A sensitive clinical decision rule for TIA patients would be used by 96.3% (95% CI 93.9–98.7) of emergency physicians. The median required sensitivity of this rule for stroke or death within 7 days was 97%.

Conclusions:

Almost half of all TIA patients are managed as outpatients,which is neither expedited nor in a dedicated stroke clinic. Emergency physicians indicate a willingness to use a highly sensitive clinical decision rule to triage TIA patients.

Keywords

clinical decision rulestransient ischemic attack (TIA)
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 13 , Issue 1 , January 2011 , pp. 19 - 27
Copyright
Copyright © Canadian Association of Emergency Physicians 2011

References

REFERENCES

1.Edlow, JA, Kim, S, Pelletier, AJ, et al. National study on emergency department visits for transient ischemic attack, 1992-2001. Acad Emerg Med 2006;13:666–72.CrossRefGoogle Scholar
2.WHO MONICA Project Principal Investigators. The World Health Organization MONICA Project (monitoring trends and determinants in cardiovascular disease): a major international collaboration. J Clin Epidemiol 1988;41:105–14.Google Scholar
3.Albers, GW, Caplan, LR, Easton, JD, et al. Transient ischemic attack—proposal for a new definition. N Engl J Med 2002;347:1713–6.CrossRefGoogle ScholarPubMed
4.Hill, MD, Yiannakoulias, N, Jeerakathil, T, et al. The high risk of stroke immediately after transient ischemic attack. Neurology 2004;62:2015–20.Google Scholar
5.Gladstone, DJ, Kapral, MK, Fang, J, et al. Management and outcomes of transient ischemic attacks in Ontario. Can Med Assoc J 2004;170:1099–104.Google Scholar
6.Lovett, JK, Dennis, MS, Sandercock, PAG, et al. Very early risk of stroke after a first transient ischemic attack. Stroke 2003;34:e138-42.Google Scholar
7.Kleindorfer, D, Panagos, P, Pancioli, A, et al. Incidence and short-term prognosis of transient ischemic attack in a population-based study. Stroke 2005;36:720–4.Google Scholar
8.Johnston, SC. Transient ischemic attacks are emergencies. Stroke 2005;36:724.Google Scholar
9.Johnston, SC, Gress, DR, Browner, WS, et al. Short-term prognosis after emergency department diagnosis of TIA. JAMA 2000;284:2901–6.CrossRefGoogle ScholarPubMed
10.Carandang, R, Seshadri, S, Beiser, A, et al. Trends in incidence, lifetime risk, severity and 30 day mortality of stroke over the past 50 years. JAMA 2009;296:2939–46.CrossRefGoogle Scholar
11.Johnston, SC. Transient ischemic attack. N Engl J Med 2002;347:1687–92.Google Scholar
12.Rothwell, PM, Giles, MF, Chandratheva, A, et al. Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison. Lancet 2007;370:1432–42.Google Scholar
13.Lavallee, PC, Meseguer, E, Abboud, H, et al. A transient ischaemic attack clinic with round-the-clock access (SOSTIA): feasibility and effects. Lancet 2007;6:953–60.CrossRefGoogle ScholarPubMed
14.Johnston, SC, Rothwell, PM, Nguyen-Huynh, MN, et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet 2007;369:283–92.CrossRefGoogle ScholarPubMed
15.Rothwell, PM, Giles, MF, Flossmann, E, et al. A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack. Lancet 2005;366:29–36.Google Scholar
16.Dillman, D. Mail and Internet surveys: the tailored design method. New York: Wiley; 2000.Google Scholar
17.Cucchiara, BL, Messe, SR, Taylor, RA, et al. Is the ABCD score useful for risk stratification of patients with acute transient ischemic attack? Stroke 2006;37:1710–4.CrossRefGoogle ScholarPubMed
18.Tsivgoulis, G, Spengos, K, Manta, P, et al. Validation of the ABCD score in identifying individuals at high early risk of stroke after a transient ischemic attack: a hospital-based case series study. Stroke 2006;37:2892–7.Google Scholar
19.Cummings, SM, Savitz, LA, Konrad, TR. Reported response rates to mailed physician questionnaires. Health Serv Res 2001;35:1347–55.Google Scholar
20.Asch, D, Jedrziewski, K, Christakis, N. Response rates to mail surveys published in medical journals. J Clin Epidemiol 1997;10:1129–36.CrossRefGoogle Scholar