Evaluation of transient ischemic attack in an emergency department observation unit

Latha G Stead, M Fernanda Bellolio, Smitha Suravaram, Robert D Brown, Anjali Bhagra, Rachel M Gilmore, Eric T Boie, Wyatt W Decker
Neurocritical Care 2009, 10 (2): 204-8

OBJECTIVE: To evaluate the feasibility of a protocol for evaluation of transient ischemic attack (TIA) in an Emergency Department Observation Unit (EDOU), and assess the risk of early stroke after such an evaluation.

METHODS: All adult patients presenting to the Emergency Department (ED) with signs and symptoms consistent with TIA were prospectively enrolled in this observational study over a period of 3 years. Patients underwent a standardized TIA evaluation per protocol. Risk of subsequent stroke at 48 h, 1 week, 1 month, and 3 months was prospectively assessed.

RESULTS: In total, 418 patients were seen during the study period, and all were evaluated per the EDOU TIA protocol. The mean age was 73.1 (+/-13.3) years and 53.8% were males. Comorbidities included hypertension in 71.5%, diabetes mellitus in 20.1%, prior TIA in 19.6%, and prior ischemic stroke in 19.6% of the cohort. Brain CT, neurology consult, electrocardiogram, carotid ultrasound, and additional tests were performed, and education was given. A total of 30.4% of the patients were dismissed directly from the EDOU. The risk of stroke at 2 days was 0.96%, at 7 days 1.2%, at 30 days 1.9%, and 2.4% at 90 days.

CONCLUSION: An Emergency Department Observation Unit Protocol for TIA is a feasible option for expedited evaluation of these patients.

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