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Related Concept Videos

Transient Ischemic Attack l: Introduction01:26

Transient Ischemic Attack l: Introduction

34
A transient ischemic attack (TIA) is a brief episode of neurological dysfunction caused by a temporary, focal reduction in cerebral blood flow. Although symptoms resemble those of an ischemic stroke, the interruption in perfusion is short-lived and does not cause permanent infarction. TIAs are clinically important because they often serve as early warning events for future stroke.Mechanisms of Transient Cerebral IschemiaTransient cerebral ischemia may arise through several mechanisms. One...
34

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Transient Ischaemic attack Emergency Referral (TIER): randomised feasibility trial results.

Alan Watkins1, Jenna Katherine Jones2, Khalid Ali3

  • 1Swansea University Medical School, Swansea University, Swansea, UK.

Emergency Medicine Journal : EMJ
|October 10, 2024
PubMed
Summary

Paramedics could not reliably identify and refer low-risk transient ischaemic attack (TIA) patients to TIA clinics, failing feasibility criteria. A large-scale trial of this prehospital TIA referral model is not recommended.

Keywords:
pre-hospitalpre-hospital carerisk managementstroke

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Area of Science:

  • Neurology
  • Emergency Medicine
  • Health Services Research

Background:

  • Early assessment of suspected transient ischaemic attack (TIA) is vital for timely preventive therapies and stroke mimic identification.
  • Emergency medical services (EMS) frequently encounter TIA patients, some of whom may not require emergency department (ED) admission.
  • A model where paramedics identify and refer low-risk TIA patients to TIA clinics, bypassing ED, requires safety and effectiveness evaluation.

Purpose of the Study:

  • To assess the feasibility of a randomized controlled trial (RCT) evaluating the clinical and cost-effectiveness of paramedic-led TIA clinic referrals.
  • To determine if paramedics can safely and effectively identify and refer low-risk TIA patients to specialized clinics, avoiding ED transfer.

Main Methods:

  • The Transient Ischaemic attack Emergency Referral (TIER) intervention was developed using surveys, a literature review, and expert consensus.
  • Paramedics in South Wales were randomized to either the TIA clinic referral intervention or usual care.
  • Progression criteria included patient referral rates, data retrieval, satisfaction, and cost-effectiveness.

Main Results:

  • The study recruited 89 paramedics and 53 patients; however, only 3 of 7 eligible intervention patients were referred to a TIA clinic.
  • Higher patient satisfaction was reported in the intervention arm (4.8/5) compared to the control arm (4.2/5).
  • Health economic analysis indicated no significant difference in quality-adjusted life-year loss between arms (p=0.475).

Conclusions:

  • The TIER feasibility study did not meet its predefined progression criteria, primarily due to low patient identification and referral rates.
  • The study suggests that a fully powered RCT evaluating this specific paramedic referral model is not recommended in the current setting.
  • Further research may be needed to refine prehospital TIA assessment and referral pathways.