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How do we manage emergency department patients diagnosed with transient ischemic attack?

Published online by Cambridge University Press:  11 May 2015

Jeffrey J. Perry ,
Jonathan Kerr ,
Cheryl Symington  and
Jane Sutherland
Jeffrey J. Perry*
Affiliation:
Department of Emergency Medicine, University of Ottawa Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON
Jonathan Kerr
Affiliation:
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON
Cheryl Symington
Affiliation:
Department of Emergency Medicine, University of Ottawa
Jane Sutherland
Affiliation:
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON
*
Clinical Epidemiology Program, F647, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, ON K1Y 4E9; [email protected]

Abstract

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Introduction:

Multiple studies have demonstrated low rates of antithrombotic use, low neuroimaging rates, and high subsequent risk of stroke at 90 days following an emergency department (ED) diagnosis of transient ischemic attack (TIA). This study assessed the use of antithrombotic medications, neuroimaging, and subsequent 90-day stroke rate for patients in a more recent cohort of ED patients discharged home with TIA.

Methods:

We conducted a 1-year historical cohort study of all patients discharged with a TIA at a tertiary care ED (census 60,000 visits/year), which was one of the four sites participating in one of the aforementioned studies. Data were extracted from paper and electronic records onto standardized data extraction forms. Clinical findings, medications, and tests were recorded.

Results:

A total of 211 patients were enrolled in the study. The patients had the following characteristics: the mean age was 71.2 years (SD 13.8 years), 56.9% were female, 53.1% had a history of hypertension, 26.5% had a history of ischemic heart disease, and 17.1% had a previous stroke. The most frequent neurologic deficit was unilateral weakness (53.6%), and most deficits lasted for more than 60 minutes (71.6%). Antithrombotic medications were used for 96.7% of patients at ED discharge. Neuroimaging was conducted in 94.3% of patients while in the ED. Our cohort had a 90-day stroke rate of 1.9%.

Conclusions:

This study established that most TIA patients receive neuroimaging in the ED and are started on or maintained on antithrombotic agents. Clinicians are encouraged to ensure that electrocardiography is done routinely and to involve Neurology in follow-up care.

Keywords

emergency departmentstroke managementtransient ischemic attack
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 14 , Issue 1 , January 2012 , pp. 20 - 24
Copyright
Copyright © Canadian Association of Emergency Physicians 2012

References

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