Transient ischemic attack: management in the emergency department and impact of an outpatient neurovascular clinic
1) To evaluate whether transient ischemic attack (TIA) management in emergency departments (EDs) of the Nova Scotia Capital District Health Authority followed Canadian Best Practice Recommendations, and 2) to assess the impact of being followed up in a dedicated outpatient neurovascular clinic. Retr...
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| Veröffentlicht in: | Canadian journal of emergency medicine 2016-09, Vol.18 (5), p.331-339 |
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| creator | Hosier, Gregory W. Phillips, Stephen J. Doucette, Steve P. Magee, Kirk D. Gubitz, Gordon J. |
| description | 1) To evaluate whether transient ischemic attack (TIA) management in emergency departments (EDs) of the Nova Scotia Capital District Health Authority followed Canadian Best Practice Recommendations, and 2) to assess the impact of being followed up in a dedicated outpatient neurovascular clinic.
Retrospective chart review of all patients discharged from EDs in our district from January 1, 2011 to December 31, 2012 with a diagnosis of TIA. Cox proportional hazards models, Kaplan-Meier survival curve, and propensity matched analyses were used to evaluate 90-day mortality and readmission.
Of the 686 patients seen in the ED for TIA, 88.3% received computed tomography (CT) scanning, 86.3% received an electrocardiogram (ECG), 35% received vascular imaging within 24 hours of triage, 36% were seen in a neurovascular clinic, and 4.2% experienced stroke, myocardial infarction, or vascular death within 90 days. Rates of antithrombotic use were increased in patients seen in a neurovascular clinic compared to those who were not (94% v. 86.3%, p |
| doi_str_mv | 10.1017/cem.2016.3 |
| format | Article |
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Retrospective chart review of all patients discharged from EDs in our district from January 1, 2011 to December 31, 2012 with a diagnosis of TIA. Cox proportional hazards models, Kaplan-Meier survival curve, and propensity matched analyses were used to evaluate 90-day mortality and readmission.
Of the 686 patients seen in the ED for TIA, 88.3% received computed tomography (CT) scanning, 86.3% received an electrocardiogram (ECG), 35% received vascular imaging within 24 hours of triage, 36% were seen in a neurovascular clinic, and 4.2% experienced stroke, myocardial infarction, or vascular death within 90 days. Rates of antithrombotic use were increased in patients seen in a neurovascular clinic compared to those who were not (94% v. 86.3%, p<0.0001). After adjustment for age, sex, vascular disease risk factors, and stroke symptoms, the risk of readmission for stroke, myocardial infarction, or vascular death was lower for those seen in a neurovascular clinic compared to those who were not (adjusted hazard ratio 0.28; 95% confidence interval 0.08-0.99, p=0.048).
The majority of patients in our study were treated with antithrombotic agents in the ED and investigated with CT and ECG within 24 hours; however, vascular imaging and neurovascular clinic follow-up were underutilized. For those with neurovascular clinic follow-up, there was an association with reduced risk of subsequent stroke, myocardial infarction, or vascular death.</description><identifier>ISSN: 1481-8035</identifier><identifier>EISSN: 1481-8043</identifier><identifier>DOI: 10.1017/cem.2016.3</identifier><identifier>PMID: 26879765</identifier><language>eng</language><publisher>New York, USA: Cambridge University Press</publisher><subject>Aged ; Aged, 80 and over ; Ambulatory Care - methods ; Ambulatory Care Facilities ; Anticoagulants - therapeutic use ; Antihypertensives ; Blood tests ; Brain research ; Cerebrovascular Disorders - diagnosis ; Cerebrovascular Disorders - mortality ; Cerebrovascular Disorders - therapy ; Cohort Studies ; Disease Progression ; Electrocardiography ; Emergency medical care ; Emergency Service, Hospital ; Endarterectomy, Carotid - methods ; Female ; Follow-Up Studies ; Heart attacks ; Hospitals ; Humans ; Information systems ; Ischemia ; Ischemic Attack, Transient - diagnosis ; Ischemic Attack, Transient - mortality ; Ischemic Attack, Transient - therapy ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Neurology ; Nova Scotia ; Original Research ; Patients ; Propensity Score ; Proportional Hazards Models ; Retrospective Studies ; Risk Assessment ; Stroke ; Survival analysis ; Survival Rate ; Time Factors ; Transient ischemic attack ; Treatment Outcome</subject><ispartof>Canadian journal of emergency medicine, 2016-09, Vol.18 (5), p.331-339</ispartof><rights>Copyright © Canadian Association of Emergency Physicians 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c388t-88503c8250519ec59c98e41be9b7f1600c76abc52e69acfa0b3f1e93ca9d98013</citedby><cites>FETCH-LOGICAL-c388t-88503c8250519ec59c98e41be9b7f1600c76abc52e69acfa0b3f1e93ca9d98013</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26879765$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hosier, Gregory W.</creatorcontrib><creatorcontrib>Phillips, Stephen J.</creatorcontrib><creatorcontrib>Doucette, Steve P.</creatorcontrib><creatorcontrib>Magee, Kirk D.</creatorcontrib><creatorcontrib>Gubitz, Gordon J.</creatorcontrib><title>Transient ischemic attack: management in the emergency department and impact of an outpatient neurovascular clinic</title><title>Canadian journal of emergency medicine</title><addtitle>CJEM</addtitle><description>1) To evaluate whether transient ischemic attack (TIA) management in emergency departments (EDs) of the Nova Scotia Capital District Health Authority followed Canadian Best Practice Recommendations, and 2) to assess the impact of being followed up in a dedicated outpatient neurovascular clinic.
Retrospective chart review of all patients discharged from EDs in our district from January 1, 2011 to December 31, 2012 with a diagnosis of TIA. Cox proportional hazards models, Kaplan-Meier survival curve, and propensity matched analyses were used to evaluate 90-day mortality and readmission.
Of the 686 patients seen in the ED for TIA, 88.3% received computed tomography (CT) scanning, 86.3% received an electrocardiogram (ECG), 35% received vascular imaging within 24 hours of triage, 36% were seen in a neurovascular clinic, and 4.2% experienced stroke, myocardial infarction, or vascular death within 90 days. Rates of antithrombotic use were increased in patients seen in a neurovascular clinic compared to those who were not (94% v. 86.3%, p<0.0001). After adjustment for age, sex, vascular disease risk factors, and stroke symptoms, the risk of readmission for stroke, myocardial infarction, or vascular death was lower for those seen in a neurovascular clinic compared to those who were not (adjusted hazard ratio 0.28; 95% confidence interval 0.08-0.99, p=0.048).
The majority of patients in our study were treated with antithrombotic agents in the ED and investigated with CT and ECG within 24 hours; however, vascular imaging and neurovascular clinic follow-up were underutilized. For those with neurovascular clinic follow-up, there was an association with reduced risk of subsequent stroke, myocardial infarction, or vascular death.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Ambulatory Care - methods</subject><subject>Ambulatory Care Facilities</subject><subject>Anticoagulants - therapeutic use</subject><subject>Antihypertensives</subject><subject>Blood tests</subject><subject>Brain research</subject><subject>Cerebrovascular Disorders - diagnosis</subject><subject>Cerebrovascular Disorders - mortality</subject><subject>Cerebrovascular Disorders - therapy</subject><subject>Cohort Studies</subject><subject>Disease Progression</subject><subject>Electrocardiography</subject><subject>Emergency medical care</subject><subject>Emergency Service, Hospital</subject><subject>Endarterectomy, Carotid - methods</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart attacks</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Information systems</subject><subject>Ischemia</subject><subject>Ischemic Attack, Transient - diagnosis</subject><subject>Ischemic Attack, Transient - mortality</subject><subject>Ischemic Attack, Transient - therapy</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neurology</subject><subject>Nova Scotia</subject><subject>Original Research</subject><subject>Patients</subject><subject>Propensity Score</subject><subject>Proportional Hazards Models</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Stroke</subject><subject>Survival analysis</subject><subject>Survival Rate</subject><subject>Time Factors</subject><subject>Transient ischemic attack</subject><subject>Treatment Outcome</subject><issn>1481-8035</issn><issn>1481-8043</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNplkcFO3DAQhq2qCCjl0geoLPWCUHdrx5vE5oZWtCAhcYFzNJlMdrONndR2kPbt8S5bVJWTPZpPn8fzM_ZFirkUsvyBZOeZkMVcfWCncqHlTIuF-vh2V_kJ-xTCRgiZ5VIfs5Os0KUpi_yU-UcPLnTkIu8Crsl2yCFGwN9X3IKDFdl9z_G4Jp4KvyKHW97QCD7ue-Aa3tkRMPKhTRUfpjhC3DsdTX54hoBTD55j37kOP7OjFvpA54fzjD39vHlc3s7uH37dLa_vZ6i0jjOtc6FQZ7nIpSHMDRpNC1mTqctWFkJgWUCNeUaFAWxB1KqVZBSCaYwWUp2xi1fv6Ic_E4VY2fRF6ntwNEyhklqahUpLMQn99h-6GSbv0nQ7Spdpa8VOePlKoR9C8NRWo-8s-G0lRbVLokpJVLskKpXgrwflVFtq3tC_q0_A94MNbO27ZkX_PPre9wLlKJO5</recordid><startdate>201609</startdate><enddate>201609</enddate><creator>Hosier, Gregory W.</creator><creator>Phillips, Stephen J.</creator><creator>Doucette, Steve P.</creator><creator>Magee, Kirk D.</creator><creator>Gubitz, Gordon J.</creator><general>Cambridge University Press</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>4T-</scope><scope>4U-</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8FQ</scope><scope>8FV</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M3G</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>S0X</scope><scope>7X8</scope></search><sort><creationdate>201609</creationdate><title>Transient ischemic attack: management in the emergency department and impact of an outpatient neurovascular clinic</title><author>Hosier, Gregory W. ; Phillips, Stephen J. ; Doucette, Steve P. ; Magee, Kirk D. ; Gubitz, Gordon J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c388t-88503c8250519ec59c98e41be9b7f1600c76abc52e69acfa0b3f1e93ca9d98013</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Ambulatory Care - methods</topic><topic>Ambulatory Care Facilities</topic><topic>Anticoagulants - therapeutic use</topic><topic>Antihypertensives</topic><topic>Blood tests</topic><topic>Brain research</topic><topic>Cerebrovascular Disorders - diagnosis</topic><topic>Cerebrovascular Disorders - mortality</topic><topic>Cerebrovascular Disorders - therapy</topic><topic>Cohort Studies</topic><topic>Disease Progression</topic><topic>Electrocardiography</topic><topic>Emergency medical care</topic><topic>Emergency Service, Hospital</topic><topic>Endarterectomy, Carotid - methods</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart attacks</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Information systems</topic><topic>Ischemia</topic><topic>Ischemic Attack, Transient - diagnosis</topic><topic>Ischemic Attack, Transient - mortality</topic><topic>Ischemic Attack, Transient - therapy</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neurology</topic><topic>Nova Scotia</topic><topic>Original Research</topic><topic>Patients</topic><topic>Propensity Score</topic><topic>Proportional Hazards Models</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Stroke</topic><topic>Survival analysis</topic><topic>Survival Rate</topic><topic>Time Factors</topic><topic>Transient ischemic attack</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hosier, Gregory W.</creatorcontrib><creatorcontrib>Phillips, Stephen J.</creatorcontrib><creatorcontrib>Doucette, Steve P.</creatorcontrib><creatorcontrib>Magee, Kirk D.</creatorcontrib><creatorcontrib>Gubitz, Gordon J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Docstoc</collection><collection>University Readers</collection><collection>ProQuest Nursing and Allied Health Source</collection><collection>ProQuest Health and Medical</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Canadian Business & Current Affairs Database</collection><collection>Canadian Business & Current Affairs Database (Alumni Edition)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest Research Library</collection><collection>CBCA Reference & Current Events</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><jtitle>Canadian journal of emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hosier, Gregory W.</au><au>Phillips, Stephen J.</au><au>Doucette, Steve P.</au><au>Magee, Kirk D.</au><au>Gubitz, Gordon J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Transient ischemic attack: management in the emergency department and impact of an outpatient neurovascular clinic</atitle><jtitle>Canadian journal of emergency medicine</jtitle><addtitle>CJEM</addtitle><date>2016-09</date><risdate>2016</risdate><volume>18</volume><issue>5</issue><spage>331</spage><epage>339</epage><pages>331-339</pages><issn>1481-8035</issn><eissn>1481-8043</eissn><abstract>1) To evaluate whether transient ischemic attack (TIA) management in emergency departments (EDs) of the Nova Scotia Capital District Health Authority followed Canadian Best Practice Recommendations, and 2) to assess the impact of being followed up in a dedicated outpatient neurovascular clinic.
Retrospective chart review of all patients discharged from EDs in our district from January 1, 2011 to December 31, 2012 with a diagnosis of TIA. Cox proportional hazards models, Kaplan-Meier survival curve, and propensity matched analyses were used to evaluate 90-day mortality and readmission.
Of the 686 patients seen in the ED for TIA, 88.3% received computed tomography (CT) scanning, 86.3% received an electrocardiogram (ECG), 35% received vascular imaging within 24 hours of triage, 36% were seen in a neurovascular clinic, and 4.2% experienced stroke, myocardial infarction, or vascular death within 90 days. Rates of antithrombotic use were increased in patients seen in a neurovascular clinic compared to those who were not (94% v. 86.3%, p<0.0001). After adjustment for age, sex, vascular disease risk factors, and stroke symptoms, the risk of readmission for stroke, myocardial infarction, or vascular death was lower for those seen in a neurovascular clinic compared to those who were not (adjusted hazard ratio 0.28; 95% confidence interval 0.08-0.99, p=0.048).
The majority of patients in our study were treated with antithrombotic agents in the ED and investigated with CT and ECG within 24 hours; however, vascular imaging and neurovascular clinic follow-up were underutilized. For those with neurovascular clinic follow-up, there was an association with reduced risk of subsequent stroke, myocardial infarction, or vascular death.</abstract><cop>New York, USA</cop><pub>Cambridge University Press</pub><pmid>26879765</pmid><doi>10.1017/cem.2016.3</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Canadian journal of emergency medicine, 2016-09, Vol.18 (5), p.331-339 |
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| subjects | Aged Aged, 80 and over Ambulatory Care - methods Ambulatory Care Facilities Anticoagulants - therapeutic use Antihypertensives Blood tests Brain research Cerebrovascular Disorders - diagnosis Cerebrovascular Disorders - mortality Cerebrovascular Disorders - therapy Cohort Studies Disease Progression Electrocardiography Emergency medical care Emergency Service, Hospital Endarterectomy, Carotid - methods Female Follow-Up Studies Heart attacks Hospitals Humans Information systems Ischemia Ischemic Attack, Transient - diagnosis Ischemic Attack, Transient - mortality Ischemic Attack, Transient - therapy Kaplan-Meier Estimate Male Middle Aged Neurology Nova Scotia Original Research Patients Propensity Score Proportional Hazards Models Retrospective Studies Risk Assessment Stroke Survival analysis Survival Rate Time Factors Transient ischemic attack Treatment Outcome |
| title | Transient ischemic attack: management in the emergency department and impact of an outpatient neurovascular clinic |
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