New Transient Ischemic Attack and Stroke

Goldstein, Larry B.; Bian, John; Samsa, Gregory P.; Bonito, Arthur J.; Lux, Linda J; Matchar, David B.

doi:10.1001/archinte.160.19.2941

Cited by 74 publications

(17 citation statements)

References 27 publications

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“…in the Netherlands, most GPs would refer to a neurologist, 36 in the US and New Zealand a cardiologist or neurologist, 22,25,37 and in the UK, a physician, geriatrician or vascular surgeon. 34 a qualitative study in the UK examined GPs' views of the aBCD2 score in influencing referrals.…”

Section: Recognition Of Urgencymentioning

confidence: 99%

“…in the US, an audit of medical records found 47% of patients with tia who were not hospitalised or with no diagnostic test performed were prescribed antiplatelet therapy. 37 in the Netherlands, a study asking GPs how they managed their last patient with tia found 74% received aspirin, 36 and a UK database study found that prescription rates within 7 days of onset of tia were 38% for antiplatelet and 1.3% for anticoagulants. 27 Further details of medication use by country are shown in table 5.…”

Section: Recognition Of Urgencymentioning

confidence: 99%

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Diagnosis and management of transient ischemic attacks in primary care: a systematic review

2017

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INTRODUCTION:Many patients who suffer a transient ischaemic attack (TIA) present to their general practitioner (GP). Early identification and treatment reduces the risk of subsequent stroke, disability and mortality. AIM:To review the accuracy of TIA diagnosis in primary care, immediate management and interventions to assist GPs with the condition. METHODS:This study included the search of Medline, Embase, Web of Science and Scopus databases . Relevant titles and abstracts were obtained using structured criteria (diagnosis, immediate management or intervention of TIAs in primary care), with full review and data extraction for eligible publications.TWo reviewers independently assessed quality and extracted information from the 24 eligible studies. The studies had heterogeneous methodology rendering meta-analysis inappropriate, so a narrative synthesis was undertaken. RESULTS:Most studies found limitations in GPs' knowledge and ability to diagnose TIAs to varying extent over time and between countries. GPs tended to over-interpret non-specific symptoms (e.g. isolated vertigo) when considering a TIA diagnosis. Reported referral behaviour varied between countries, with some favouring admission and others preferring outpatient management. Consistent under-referral and under-use of effective medication was reported. However, GPs may refer some patients to exclude rather than confirm a final diagnosis. This, alongside evidence of under-referral, suggests the need for education and decision support tools to enhance referral patterns. Intervention studies suggested that electronic decision support may increase referrals and timely management.CONCLUSION: This review revealed deficiencies in knowledge and clinical practice, and identified potential avenues to addressing these. Issues for future research were also identified.

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Section: Recognition Of Urgencymentioning

confidence: 99%

Section: Recognition Of Urgencymentioning

confidence: 99%

Diagnosis and management of transient ischemic attacks in primary care: a systematic review

2017

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“…Earlier studies found that a third of patients diagnosed with TIA in primary care clinics were not hospitalized and did not receive further tests or treatment [ 8 ]. Studies from Japan, France, Poland, Australia and the United States affirmed that most physicians are undereducated about the risk of stroke after TIA; many found it difficult to manage these patients [ 6 , 7 , 9 , 10 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

Awareness of Stroke Risk after TIA in Swiss General Practitioners and Hospital Physicians

et al. 2015

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BackgroundTransient ischemic attacks (TIA) are stroke warning signs and emergency situations, and, if immediately investigated, doctors can intervene to prevent strokes. Nevertheless, many patients delay going to the doctor, and doctors might delay urgently needed investigations and preventative treatments. We set out to determine how much general practitioners (GPs) and hospital physicians (HPs) knew about stroke risk after TIA, and to measure their referral rates.MethodsWe used a structured questionnaire to ask GPs and HPs in the catchment area of the University Hospital of Bern to estimate a patient’s risk of stroke after TIA. We also assessed their referral behavior. We then statistically analysed their reasons for deciding not to immediately refer patients.ResultsOf the 1545 physicians, 40% (614) returned the survey. Of these, 75% (457) overestimated stroke risk within 24 hours, and 40% (245) overestimated risk within 3 months after TIA. Only 9% (53) underestimated stroke risk within 24 hours and 26% (158) underestimated risk within 3 months; 78% (473) of physicians overestimated the amount that carotid endarterectomy reduces stroke risk; 93% (543) would rigorously investigate the cause of a TIA, but only 38% (229) would refer TIA patients for urgent investigations “very often”. Physicians most commonly gave these reasons for not making emergency referrals: patient’s advanced age; patient’s preference; patient was multimorbid; and, patient needed long-term care.ConclusionsAlthough physicians overestimate stroke risk after TIA, their rate of emergency referral is modest, mainly because they tend not to refer multimorbid and elderly patients at the appropriate rate. Since old and frail patients benefit from urgent investigations and treatment after TIA as much as younger patients, future educational campaigns should focus on the importance of emergency evaluations for all TIA patients.

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“…Moreover, when the patient is admitted, his enrolling in the hospital organization involves times that are more or less extended for carrying out all the complementary studies. As for patients who come in to Urgent Care with symptoms that are compatible with TIA, it is usual for them to be sent back to their Primary Care physician, who in the best-case scenario, refers them for a further outpatient study by Neurology [12,13], with the consequential delay in the diagnosis and optimal treatment. Taking into consideration that the risk of stroke after suffering a TIA is up to 15% in the first 15 days [14-16], the ineffectiveness of the current management of TIA is easily deduced, as it is the impossibility derived to prevent strokes.…”

Section: Discussionmentioning

confidence: 99%

Long term evolution of patients treated in a TIA unit

Fernández¹,

Calleja²,

Larrosa³

et al. 2013

Int Arch Med

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BackgroundTransient ischemic attacks (TIA) entail a high risk of stroke recurrence, which depends on the etiology. New organizational models have been created, but there is not much information about the long-term evolution of patients managed according to these premises. Our aim is to refer the follow-up of patients attended according to our model of TIA Unit.MethodsTIA Unit is located in the Emergency Department and staffed by vascular neurologists. Patients admitted during the Neurology night shift stayed in such Unit <48h with complete etiological study. Preventive treatment is instituted in patients discharged to a high resolution Neurology consult, in order to review in <2 weeks and subsequent follow-up.ResultsDuring a year 161 patients were attended, being admitted to the hospital 8.6%. A total of 1470 hospital days were avoided. Recurrence at 90 days was of 0.6%. Mean follow-up was 18.14 ± 8.02 months (0–34), total recurrence 6.2% (70% cardioembolic strokes). There were no complications derived from treatment. Cardiological events were recorded in 10.6%, neoplastic in 5%, cognitive impairment in 11%. There were 3 deaths unrelated nor to the stroke or its treatment.ConclusionsThis model allows an early diagnosis and treatment of TIA, preventing recurrences of stroke in a long term. It detects atherothrombotic strokes, most of them admitted to the hospital, and it shows a greater difficulty for detecting all cardioembolic strokes. TIA Unit appeared to be safe in using anticoagulation therapy, as the follow-up shows. It shows the same quality of management than hospital admission, with a significant saving in hospital stays.

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New Transient Ischemic Attack and Stroke

Cited by 74 publications

References 27 publications

Diagnosis and management of transient ischemic attacks in primary care: a systematic review

Diagnosis and management of transient ischemic attacks in primary care: a systematic review

Awareness of Stroke Risk after TIA in Swiss General Practitioners and Hospital Physicians

Long term evolution of patients treated in a TIA unit

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