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Taylor RS, Opara NU, Burg J. Comparing Treatment Outcomes Between In-Hospital and Emergency Department Management of Patients With Transient Ischemic Attacks. Cureus 2021; 13:e20261. [PMID: 35004065 PMCID: PMC8735838 DOI: 10.7759/cureus.20261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 11/09/2022] Open
Abstract
Introduction A transient ischemic attack (TIA) is a medical emergency, as it is a sudden neurological episode caused by ischemia in a vascular territory in the brain, which lasts less than one hour. TIA definition has shifted from time-based to tissue-based according to modern literature. It is considered a warning sign for an impending stroke. Symptoms could range from weakness on one side of the body, diaphoresis, to slurred speech. In this study, we examined the differences in health outcomes, when patients diagnosed with TIA are treated and discharged home from the ED, versus when admitted to the hospital for additional care. Methods This is a descriptive and retrospective study. We examined all patients’ encounters from January 1, 2018 to December 31, 2019 at four emergency department locations. The cohort compared patients diagnosed with a TIA who takes medications (anti-lipid, antiplatelet drugs) versus patients diagnosed with a TIA who are not on any preventive medication. We compared the hospital readmission rate between these two group of patients and the need for additional medical treatments. Our study also considered hospital length of stay (LOS), admission rate, and its impact on patients with comorbidities. Results There were 983 patients included in the study. The patients on TIA prophylactic medications prior to coming to the ED made up (60.7%), and (51.2%) in this group required additional medications during hospital admission. The remaining 162 (39.3%), p=0.001 patients, were not on TIA prophylactic medications prior to presenting in the ED. The patients who required additional medications while in the ED were significantly older (mean +/-SD, 68.6 +/-14.0 years versus 62.18 +/- 17.4 years, p=0.001). Following a multivariate analysis, age greater than 60 (CI: 3.52-3.91, p=0.001) and results of the head CT/MRI investigations for any signs of neurological damage, were all found to be independent predictors of longer hospital stay and treatment outcomes. There were no significant differences in the treatment outcome for patients with TIA based on longer hospital stay and extra medication administration in the ED. Conclusion In our study, we observed that approximately, 75% of the patients who were on TIA prophylactic medications prior to presenting in the ED with symptoms of TIA were admitted to the hospital for further monitoring, compared to other group of patients who were not on TIA medications. We did also noted that there were no differences in mortality outcome between patients treated and discharged from the ED, versus patients admitted to the hospital for additional treatment. Lastly, patients who are 68 years and older, made up two-thirds of patient population admitted in the hospital and required additional medications, compared to younger patients.
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Duncan PW, Abbott RM, Rushing S, Johnson AM, Condon CN, Lycan SL, Lutz BJ, Cummings DM, Pastva AM, D’Agostino RB, Stafford JM, Amoroso RM, Jones SB, Psioda MA, Gesell SB, Rosamond WD, Prvu-Bettger J, Sissine ME, Boynton MD, Bushnell CD. COMPASS-CP: An Electronic Application to Capture Patient-Reported Outcomes to Develop Actionable Stroke and Transient Ischemic Attack Care Plans. Circ Cardiovasc Qual Outcomes 2018; 11:e004444. [DOI: 10.1161/circoutcomes.117.004444] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Pamela W. Duncan
- Department of Neurology (P.W.D., R.M.A., C.N.C., S.L.L., M.E.S., C.D.B.)
| | - Rica M. Abbott
- Department of Neurology (P.W.D., R.M.A., C.N.C., S.L.L., M.E.S., C.D.B.)
| | - Scott Rushing
- Division of Public Health Sciences, Department of Biostatistical Sciences (S.R., R.B.D., J.M.S., R.M.A.)
| | - Anna M. Johnson
- Wake Forest School of Medicine, Winston-Salem, NC. Department of Epidemiology (A.M.J., S.B.J., W.D.R., R.M.A.)
| | | | - Sarah L. Lycan
- Department of Neurology (P.W.D., R.M.A., C.N.C., S.L.L., M.E.S., C.D.B.)
| | - Barbara J. Lutz
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill. School of Nursing, University of North Carolina Wilmington (B.J.L.)
| | - Doyle M. Cummings
- Department of Family Medicine, Brody School of Medicine, East Carolina University, Greenville, NC (D.M.C.)
| | - Amy M. Pastva
- Division of Physical Therapy, Department of Orthopaedic Surgery (A.M.P.)
| | - Ralph B. D’Agostino
- Division of Public Health Sciences, Department of Biostatistical Sciences (S.R., R.B.D., J.M.S., R.M.A.)
| | - Jeanette M. Stafford
- Division of Public Health Sciences, Department of Biostatistical Sciences (S.R., R.B.D., J.M.S., R.M.A.)
| | - Robert M. Amoroso
- Division of Public Health Sciences, Department of Biostatistical Sciences (S.R., R.B.D., J.M.S., R.M.A.)
- Wake Forest School of Medicine, Winston-Salem, NC. Department of Epidemiology (A.M.J., S.B.J., W.D.R., R.M.A.)
| | - Sara B. Jones
- Wake Forest School of Medicine, Winston-Salem, NC. Department of Epidemiology (A.M.J., S.B.J., W.D.R., R.M.A.)
| | | | | | - Wayne D. Rosamond
- Wake Forest School of Medicine, Winston-Salem, NC. Department of Epidemiology (A.M.J., S.B.J., W.D.R., R.M.A.)
| | - Janet Prvu-Bettger
- Department of Orthopaedic Surgery (J.P.-B.), Duke University School of Medicine, Durham, NC
| | - Mysha E. Sissine
- Department of Neurology (P.W.D., R.M.A., C.N.C., S.L.L., M.E.S., C.D.B.)
| | - Mark D. Boynton
- Sticht Center on Aging, Pain Management and Rehabilitation Advisory Council (M.D.B.)
| | - Cheryl D. Bushnell
- Department of Neurology (P.W.D., R.M.A., C.N.C., S.L.L., M.E.S., C.D.B.)
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