National Study on Emergency Department Visits for Transient Ischemic Attack, 1992–2001

Abstract

Objectives: To describe the epidemiology of U.S. emergency department (ED) visits for transient ischemic attack (TIA) and to measure rates of antiplatelet medication use, neuroimaging, and hospitalization during a ten-year time period.Methods: The authors obtained data from the 1992-2001 National Hospital Ambulatory Medical Care Survey. TIA cases were identified by having ICD-9 code 435.Results: From 1992 to 2001, there were 769 cases, representing 2,969,000 ED visits for TIA. The population rate of 1.1 ED visits per 1,000 U.S. population (95% CI = 0.92 to 1.30) was stable over time. TIA was diagnosed in 0.3% of all ED visits. Physicians administered aspirin and other antiplatelet agents to a small percentage of patients, and 42% of TIA patients (95% CI = 29% to 55%) received no medications at all in the ED. Too few data points existed to measure a statistically valid trend over time. Physicians performed computed tomography scanning in 56% (95% CI = 45% to 66%) of cases and performed magnetic resonance imaging (MRI) in <5% of cases, and there was a trend toward increased imaging over time. Admission rates did not increase during the ten-year period, with 54% (95% CI = 42% to 67%) admitted. Regional differences were noted, however, with the highest admission rate found in the Northeast (68%).Conclusions: Between 1992 and 2001, the population rate of ED visits for TIA was stable, as were admission rates (54%). Antiplatelet medications appear to be underutilized and to be discordant with published guidelines. Neuroimaging increased significantly. These findings may reflect the limited evidence base for the guidelines, educational deficits, or other barriers to guideline implementation.ACADEMIC EMERGENCY MEDICINE 2006; 13:666-672 ª

Copeptin for the Prediction of Recurrent Cerebrovascular Events After Transient Ischemic Attack

“…These findings are relevant given the high incidence of TIA and their heterogeneous management. In the United States, there is an estimate of 1 emergency department visit for TIA per 1000 people and year, 20 similar to the United Kingdom with 0.7 per 1000 people and year. 21 Although all patients with TIA need urgent work-up, not all patients with TIA need to be hospitalized.…”

Addition of Brain Infarction to the ABCD 2 Score (ABCD 2 I)

“…In a countrywide survey of ED attenders with TIA in the United States from the National Hospital Ambulatory Medical Care Survey (NHAMCS) up to 2001, 56% of patients received CT imaging and Ͻ5% received MRI, although rates of MRI will have increased subsequently. 26 However, despite its availability, CT has the disadvantages of reduced sensitivity for early infarction and radiation exposure and MRI with DWI remains the imaging modality of choice in TIA. 9,10 The use of the ABCD 2 score for identifying either high-or low-risk groups currently differs between healthcare systems.…”

Factors Associated With Length of Hospitalization in Patients Admitted With Transient Ischemic Attack in United States

“…The recent rate is higher than the 54% rate of hospitalization reported among 2 969 000 TIA patients presenting to the ED from 1992 to 2001. 6 Implementation of TIA clinics for early management of low-to moderate-risk TIA patients has reduced the proportion of patients requiring hospital admission, but the need and length of hospitalization remains an issue. 7,8 Even with implementation of rapid outpatient assessment and management, 18% of patients with TIA or minor stroke in phase 2 of Early use of Existing Preventive Strategies for Stroke (EXPRESS) study and 26% of roundthe-clock access (SOS-TIA) study required hospital admission.…”