Emergency department evaluation of ischemic stroke and TIA: the BASIC Project

Area of Science:

• Neurology
• Public Health
• Emergency Medicine

Background:

• Acute stroke care delivery in emergency departments (EDs) is critical for patient outcomes.
• Understanding demographic and clinical factors influencing ED practices for acute cerebrovascular events is essential for targeted interventions.

Purpose of the Study:

• To identify demographic and clinical variables associated with emergency department (ED) practices in a community-based acute stroke study.
• To evaluate the utilization of neurology consultations and brain imaging in the ED for acute cerebrovascular disease.

Main Methods:

• A population-based surveillance study (Brain Attack Surveillance in Corpus Christi Project) identified cerebrovascular disease cases from 2000-2002.
• Multivariable logistic regression analyzed variables associated with hospital admission, brain imaging, and neurologist consultation in the ED.
• Key variables included demographics, stroke type (ischemic stroke or TIA), vascular risk factors, and symptom presentation.

Main Results:

• Of 1796 patients (941 Mexican Americans, 855 non-Hispanic whites), 66% had ischemic stroke and 34% had TIA.
• Only 8% received an in-person neurology consultation, and 12% did not receive head imaging.
• Transient Ischemic Attack (TIA) was associated with lower odds of neurology consultation and hospital admission. Mexican Americans had lower odds of ED neurology consultation compared to non-Hispanic whites.

Conclusions:

• Neurologist involvement in acute cerebrovascular care within the ED is infrequent, particularly for TIA patients.
• Enhanced neurologist participation in the ED may lead to improved acute stroke diagnosis and treatment.
• Disparities in ED neurology consultation exist among ethnic groups.