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Updated: Jan 23, 2026

Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide
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Initiation of the ABCD3-I algorithm for expediated evaluation of transient ischemic attack patients in an emergency

Robert T Dahlquist1, Joseph M Young1, Karina Reyner1

  • 1Department of Emergency Medicine, Baylor University Medical Center, 3500 Gaston Ave., Dallas, TX 75246, United States of America.

The American Journal of Emergency Medicine
|June 25, 2019
PubMed

Insights

Implementing the ABCD3-I score pathway in the emergency department (ED) significantly reduced hospital admissions and costs for transient ischemic attack (TIA) patients. This expedited evaluation maintained similar 90-day stroke outcomes, improving care efficiency.

Area of Science:

  • Emergency Medicine
  • Neurology
  • Health Services Research

Background:

  • Transient ischemic attack (TIA) evaluation in the emergency department (ED) lacks standardized, widely investigated scores.
  • The ABCD3-I score's utility for expedited TIA assessment in the ED requires further study.

Purpose of the Study:

  • To evaluate the performance and cost-effectiveness of an ABCD3-I score-based pathway for TIA patients in the ED.
  • To determine if this pathway impacts hospital admission rates, healthcare costs, and patient outcomes.

Main Methods:

  • A single-center, pre- and post-intervention study design was employed.
  • Data collected included ED length of stay, hospital admissions, healthcare costs, and 90-day stroke occurrence.
  • The ABCD3-I algorithm was implemented after an initial seven-month pre-implementation phase.

Main Results:

  • Hospital admissions decreased significantly from 92% pre-implementation to 24% post-implementation (p < 0.001).
  • The ABCD3-I pathway resulted in over 40% savings in total healthcare costs per patient.
  • No significant difference in 90-day stroke occurrence was observed between the cohorts.

Conclusions:

  • An ABCD3-I based pathway for TIA evaluation in the ED significantly reduces hospital admissions and healthcare costs.
  • This expedited pathway maintains comparable 90-day neurological outcomes.
  • The ABCD3-I score offers a cost-effective and efficient approach to TIA management in the ED.
Abstract

Keywords:
ABCD3-IEmergency departmentMagnetic resonance imagingTransient ischemic attack

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