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Minor ischemic stroke: Triaging, disposition, and outcome.

Shadi Yaghi1, Joshua Z Willey1, Pooja Khatri1

  • 1Department of Neurology, Division of Stroke and Cerebrovascular Diseases (SY), The Alpert Medical School of Brown University, Providence, RI; Department of Neurology, Division of Stroke and Cerebrovascular Diseases (JZW), Columbia University Medical Center, New York, NY; and Department of Neurology, Division of Stroke and Cerebrovascular Diseases (PK), University of Cincinnati, OH.

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Summary

For mild stroke patients, outpatient evaluation may be cost-effective if large artery issues are ruled out and rapid access is ensured. Further research is needed on cost-effectiveness and safety.

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Area of Science:

  • Neurology
  • Stroke Medicine
  • Health Economics

Background:

  • Two-thirds of stroke patients present with mild deficits, necessitating optimized, cost-effective triaging strategies.
  • Current optimal management and disposition for patients with minor ischemic stroke remain unclear.
  • Effective patient stratification is crucial for determining inpatient versus outpatient evaluation needs.

Approach:

  • A comprehensive literature review of randomized trials, retrospective studies, case series, and case reports on minor ischemic stroke was conducted.
  • Evidence-based opinions and future research directions were extrapolated for managing minor ischemic stroke.
  • The approach focused on risk stratification for stroke recurrence, outpatient diagnostic feasibility, and identifying disabling deficits requiring inpatient care.

Key Points:

  • Triage decisions for mild stroke should consider early stroke recurrence risk.
  • Feasibility of outpatient diagnostic evaluation is a key factor in disposition planning.
  • Disabling deficits requiring physical and occupational therapy necessitate inpatient evaluation.

Conclusions:

  • Outpatient evaluation for nondisabling minor stroke is potentially cost-effective.
  • Cost-effectiveness is contingent upon excluding large artery atherosclerosis and ensuring rapid outpatient access.
  • Larger studies are required to validate the cost-effectiveness and safety of outpatient evaluation for minor stroke.