Abstract
Background
While transient ischemic attack and minor stroke (TIAMS) are common conditions evaluated
in the emergency department (ED), there is controversy regarding the most effective
and efficient strategies for managing them in the ED. Some patients are discharged
after evaluation in the ED and cared for in the outpatient setting, while others remain
in an observation unit without being admitted or discharged, and others experience
prolonged and potentially costly inpatient admissions.
Objective of the Review
The goal of this clinical review was to summarize and present recommendations regarding
the disposition of TIAMS patients in the ED (e.g., admission vs. discharge).
Discussion
An estimated 250,000 to 300,000 TIA events occur each year in the United States, with
an estimated near-term risk of subsequent stroke ranging from 3.5% to 10% at 2 days,
rising to 17% by 90 days. While popular and easy to use, reliance solely on risk-stratification
tools, such as the ABCD2, should not be used to determine whether TIAMS patients can
be discharged safely. Additional vascular imaging and advanced brain imaging may improve
prediction of short-term neurologic risk. We also review various disposition strategies
(e.g., inpatient vs. outpatient/ED observation units) with regard to their association
with neurologic outcomes, such as 30-day or 90-day stroke recurrence or new stroke,
in addition to other outcomes, such as hospital length of stay and health care costs.
Conclusions
Discharge from the ED for rapid outpatient follow-up may be a safe and effective strategy
for some forms of minor stroke without disabling deficit and TIA patients after careful
evaluation and initial ED workup. Future research on such strategies has the potential
to improve neurologic and overall patient outcomes and reduce hospital costs and ED
length of stay.
Keywords
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Article info
Publication history
Published online: January 08, 2018
Accepted:
December 1,
2017
Received in revised form:
November 5,
2017
Received:
July 22,
2017
Identification
Copyright
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