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

Area of Science:

• Neurology
• Emergency Medicine
• Cardiovascular Research

Background:

• Previous studies indicated suboptimal care for transient ischemic attack (TIA) patients diagnosed in emergency departments (EDs), marked by low antithrombotic use, infrequent neuroimaging, and elevated 90-day stroke risk.
• This research examines a contemporary cohort to evaluate current management and outcomes for ED patients discharged with a TIA diagnosis.

Purpose of the Study:

• To assess the utilization of antithrombotic medications and neuroimaging in a recent cohort of emergency department (ED) patients diagnosed with transient ischemic attack (TIA).
• To determine the 90-day stroke rate in this contemporary cohort of ED patients discharged with TIA.

Main Methods:

• A 1-year historical cohort study was conducted at a tertiary care ED.
• Data were retrospectively collected from paper and electronic health records for 211 patients discharged with a TIA diagnosis.
• Key clinical findings, prescribed medications, and diagnostic tests were systematically recorded.

Main Results:

• The cohort comprised 211 patients, with a mean age of 71.2 years; 56.9% were female.
• High rates of appropriate care were observed: 96.7% received antithrombotic medications at discharge, and 94.3% underwent neuroimaging in the ED.
• The 90-day stroke rate in this cohort was 1.9%.

Conclusions:

• The findings demonstrate that contemporary TIA management in the ED setting includes high rates of neuroimaging and antithrombotic therapy.
• These improved care patterns are associated with a reduced subsequent stroke risk.
• Recommendations include routine electrocardiography and neurology consultation for TIA patients.