Is admission medically justified for all patients with acute stroke or transient ischemic attack?

To determine whether admission to an acute care hospital is medically justified for all patients with acute stroke or transient ischemic attack (TIA) and whether those patients for whom admission is justified can be identified in the emergency department.

Retrospective descriptive study.

Urban county teaching hospital.

Consecutive adult patients seen in an ED with nonhemorrhagic stroke, TIA, or hemorrhagic stroke.

Admission to an acute care hospital was deemed medically justified when the patient had any of the following criteria: another diagnosis that warranted admission, an inadequate home situation, altered mental status, or an adverse event during hospitalization or if they underwent hospital-based treatment that could not be provided on an outpatient basis.

One hundred sixty-eight patients were seen during a 1-year period: 120 had an ED diagnosis of nonhemorrhagic stroke, 22 had a diagnosis of TIA, and 26 had a diagnosis of hemorrhagic stroke. One hundred sixty-one patients (96%) were admitted to our hospital. Sixty-three of the 161 admissions (39%) were retrospectively categorized as medically justified. Seventeen of the 63 patients (27%) whose admissions were medically justified developed the criteria justifying their admission after leaving the ED.

The practice of admitting all patients with nonhemorrhagic stroke, TIA, or hemorrhagic stroke to an acute care hospital is medically justified because the ED evaluation cannot reliably identify patients whose condition will worsen.