Transient Ischemic Attack and Minor Stroke

Comparing Treatment Outcomes Between In-Hospital and Emergency Department Management of Patients With Transient Ischemic Attacks

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.