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Performing Duplex within 72 Hours of Transient Ischemic Attack May Decrease Mortality, the Israeli National Program
Yaron Niv1,2, Michael Kuniavsky1, Olga Bronshtein1
1Israeli National Program for Quality Indicators (INPQ), Ministry of Health, Jerusalem, Israel.
Insights
Promptly performing carotid artery duplex scans within 72 hours of transient ischemic attack (TIA) diagnosis significantly reduces mortality. This crucial diagnostic imaging helps identify stenosis and plaque, guiding timely interventions to prevent strokes.
Area of Science:
- Vascular Neurology
- Diagnostic Imaging
- Public Health
Background:
- Transient ischemic attack (TIA) is a critical warning sign for cerebrovascular accident (stroke).
- Diagnostic imaging, specifically carotid artery duplex ultrasound, plays a vital role in identifying stenosis and atherosclerotic plaque.
- Early detection and intervention, such as endarterectomy, are key to reducing stroke risk after TIA.
Purpose of the Study:
- To evaluate the performance rates of carotid artery duplex scans performed within 72 hours of TIA diagnosis.
- To assess the impact of timely duplex scans on patient outcomes.
Main Methods:
- Retrospective analysis of patients admitted to emergency departments with TIA diagnoses (ICD9 codes).
- Inclusion criteria: patients over 18 years old admitted for TIA.
- Data collection focused on the proportion of patients undergoing duplex ultrasound within 72 hours of admission and 30-day mortality rates.
Main Results:
- Performance rates for duplex scans within 72 hours improved from 58% in 2015 to 83% in 2018.
- Over 21,538 TIA patients were analyzed from 2015-2018; 72.9% received duplex within 72 hours.
- Patients undergoing duplex within 72 hours had a significantly lower 30-day mortality rate (0.81% vs. 2.37%), a 65.82% reduction.
Conclusions:
- Performing carotid artery duplex scans within 72 hours of TIA diagnosis is associated with a significant reduction in mortality.
- Timely diagnostic imaging following TIA is crucial for improving patient survival and potentially preventing future strokes.
Background:
With diagnostic imaging, such as a duplex of the carotid arteries, finding of stenosis and atherosclerotic plaque and consequent end arterectomy may be important for decreasing the danger of developing cerebrovascular accident after transient ischemic attack (TIA).
Objectives:
To measure performance rates of duplex of carotid arteries within 72 hours of TIA diagnosis.
Methods:
The denominator included all patients who were admitted to emergency departments because of TIA, and the numerator included those who underwent duplex within 72 hours of admission. Inclusion criteria included all patients older than 18 years who were admitted because of TIA according to the ICD9 codes.
Results:
Measuring this indicator started in 2015 with 5504 patients and a 58% success rate. The figures for the years 2016, 2017, and 2018 were 5309, 5447, and 5278 patients with success rates of 73%, 79%, and 83%, respectively. Six of 26 hospitals (23.0%) reached the target of 80% in 2018. From 2015 to 2018 a total of 21,538 patients were admitted to emergency departments in Israel and diagnosed with TIA. Of these, 15,722 (72.9%) underwent duplex within 72 hours. The mortality rate within 30 days from diagnosis was 0.81% in patients who performed duplex within 72 hours of diagnosis and 2.37% in patients who did not, odds ratio 2.676, 95% confidence interval 2.051-3.492, P < 0.0001. These results indicate a statistically significant decrease of 65.82.
Conclusions:
A significant decrease in mortality was noted in patients with a new diagnosis of TIA who underwent duplex within 72 hours of diagnosis.
