Rapid assessment of transient ischaemic attack in a hospital with no on-call neurologist

Soler, Ernest Palomeras; Felip, P. Fossas; Orgaz, A.T. Cano; Cartagena, P. Sanz; Ruiz, V. Casado; Batista, D. Muriana

doi:10.1016/j.nrleng.2015.05.004

Cited by 3 publications

(16 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A total of 71 studies were included (A. Mowla, MD, unpublished data, 2020). 9 , 15 , 27 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 ...…”

Section: Resultsmentioning

confidence: 99%

“…9 , 29 , 30 , 31 , 32 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 Among the inpatients (33 cohorts; 130 139 patients; mean [SD] age, 78.3 [4.0] years; 49 458 of 128 745 [38.4%] men), 21 cohorts (125 719 patients) received care in medical-surgical units (A. Mowla, MD, unpublished data, 2020), 9 , 15 , 27 , 32 , 38 , 39 , 40 , 41 , 51 , 52 , 53 , 55 , 58 , 59 , 64 , 65 , 79 , 81 , 83 , 84 5 cohorts (2487 patients) in stroke units, 49 , 63 , 79 , 80 , 92 and 7 cohorts (1933 patients) in observation units. 48 , 65 , 66 , 82 , 83 , 84 , 95 In 16 cohorts (3605 patients; mean [SD] age, 68.9 [3.9] years; 1596 of 3046 [52.4%] men), the acute care was offered at the ED (A. Mowla, MD, unpublished data, 2020). 15 , 33 , 34 , 35 , 36 , 37 , 40 , 61 , 67...…”

Section: Resultsmentioning

confidence: 99%

“…As presented in the eTable 4 in the Supplement , the difference among estimated risk of subsequent stroke measured by seven estimators (DL, HE, HS, ML, REML, SJ, and EB) was negligible. The forest plots based on the REML estimator 43 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 96 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 , …”

Section: Resultsmentioning

confidence: 99%

“…eTable 7 in the Supplement summarizes the results of the risk of bias assessment according to ROBINS-E. Among the 63 cohorts with specified settings (ie, TIA clinic, inpatient, and ED) 59 cohorts (90.6%) had low risk of bias, 9 , 13 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 40 , 41 , 42 , 43 , 44 , 45 , 48 , 49 , 50 , 51 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 79 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 90 , 91 ...…”

Section: Resultsmentioning

confidence: 99%

“…27,29,30,32,[50][51][52][53]97 TIA was defined based on a tissue-based definition in 7 studies (9.8%) 33,52,[54][55][56][57] (and A. Mowla, MD, unpublished data, 2020). The men), 21 cohorts (125 719 patients) received care in medical-surgical units (A. Mowla, MD, unpublished data, 2020), 9,15,27,32,[38][39][40][41][51][52][53]55,58,59,64,65,79,81,83,84 5 cohorts (2487 patients) in stroke units, 49,63,79,80,92 and 7 cohorts (1933 patients) in observation units. 48,65,66,[82][83][84]95 In 16 cohorts (3605 patients; mean [SD] age, 68.9 [3.9] years; 1596 of 3046 [52.4%] men), the acute care was offered at the ED (A. Mowla, MD, unpublished data, 2020).…”

Section: Patient Characteristicsmentioning

confidence: 99%

See 4 more Smart Citations

Risk of Subsequent Stroke Among Patients Receiving Outpatient vs Inpatient Care for Transient Ischemic Attack

et al. 2022

View full text Add to dashboard Cite

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Patient Characteristicsmentioning

confidence: 99%

See 3 more Smart Citations

Risk of Subsequent Stroke Among Patients Receiving Outpatient vs Inpatient Care for Transient Ischemic Attack

et al. 2022

View full text Add to dashboard Cite

show abstract

A 5-Decade Analysis of Incidence Trends of Ischemic Stroke After Transient Ischemic Attack

et al. 2021

View full text Add to dashboard Cite

IMPORTANCE Management of transient ischemic attack (TIA) has gained significant attention during the past 25 years after several landmark studies indicated the high incidence of a subsequent stroke.OBJECTIVE To calculate the pooled event rate of subsequent ischemic stroke within 2, 7, 30, and 90 days of a TIA and compare this incidence among the population with TIA recruited before 1999 (group A), from 1999 to 2007 (group B), and after 2007 (group C).DATA SOURCES All published studies of TIA outcomes were obtained by searching PubMed from 1996, to the last update on January 31, 2020, irrespective of the study design, document type, or language.STUDY SELECTION Of 11 516 identified citations, 175 articles were relevant to this review. Both the classic time-based definition of TIA and the new tissue-based definition were accepted. Studies with a combined record of patients with TIA and ischemic stroke, without clinical evaluation for the index TIA, with diagnosis of index TIA event after ischemic stroke occurrence, with low suspicion for TIA, or duplicate reports of the same database were excluded. DATA EXTRACTION AND SYNTHESISThe study was conducted and reported according to the PRISMA, MOOSE, and EQUATOR guidelines. Critical appraisal and methodological quality assessment used the Quality in Prognosis Studies tool. Publication bias was visualized by funnel plots and measured by the Begg-Mazumdar rank correlation Kendall τ 2 statistic and Egger bias test. Data were pooled using double arcsine transformations, DerSimonian-Laird estimator, and random-effects models. MAIN OUTCOMES AND MEASURESThe proportion of the early ischemic stroke after TIA within 4 evaluation intervals (2, 7, 30, and 90 days) was considered as effect size.RESULTS Systematic review yielded 68 unique studies with 223 866 unique patients from 1971 to 2019. The meta-analysis included 206 455 patients (58% women) during a span of 4 decades. The overall subsequent ischemic stroke incidence rates were estimated as 2.4% (95% CI, 1.8%-3.2%) within 2 days, 3.8% (95% CI, 2.5%-5.4%) within 7 days, 4.1% (95% CI, 2.4%-6.3%) within 30 days, and 4.7% (95% CI, 3.3%-6.4%) within 90 days. There was a recurrence risk of 3.4% among group A in comparison with 2.1% in group B or 2.1% in group C within 2 days; 5.5% in group A vs 2.9% in group B or 3.2% in group C within 7 days; 6.3% in group A vs 2.9% in group B or 3.4% in group C within 30 days, and 7.4% in group A vs 3.9% in group B or 3.9% in group C within 90 days.CONCLUSIONS AND RELEVANCE These findings suggest that TIA continues to be associated with a high risk of early stroke; however, the rate of post-TIA stroke might have decreased slightly during the past 2 decades.

show abstract

A Current Estimation of the Early Risk of Stroke after Transient Ischemic Attack: A Systematic Review and Meta-Analysis of Recent Intervention Studies

et al. 2016

View full text Add to dashboard Cite

Objective: Recent studies have demonstrated that there is a decrease in the risk of subsequent stroke after transient ischemic attack (TIA) when urgent care (UC) is administered. However, no meta-analysis has been developed with contemporaneous TIA studies. We perform a systematic review and a meta-analysis to establish the risk of early stroke recurrence (SR) considering data from studies that offered UC to TIA patients. Methods: We searched for studies, without language restriction, from January 2007 to January 2015 according to PRISMA guidelines. We included studies with TIA patients who underwent UC and reported the proportion of SR at 90 days. We excluded studies that were centered on less than 100 patients and cohorts including both stroke and TIA, if stroke risk after TIA was not described. For its relevance, we included the TIAregistry.org study published in 2016. We performed both fixed and random effects meta-analyses to determine SR and assess sources of heterogeneity. Results: From 4,103 identified citations, we selected 15 papers that included 14,889 patients. There was great variation in terms of the number of patients included in each study, ranging from 115 to 4,160. Seven studies were TIA clinic based. The mean age and the percentage of men were similar among studies, ranging from 62.4 to 73.1 years and 45.1-62%, respectively. The reported risk of stroke ranged from 0 to 1.46% 2 days after TIA (9 studies included), 0-2.55% 7 days after TIA (11 studies included), 1.91-2.85% 30 days after TIA (4 studies included), and 0.62-4.76% 90 days after TIA (all studies included). The pooled stroke risk was 3.42% (95% CI 3.14-3.74) at 90 days, 2.78% (95% CI 2.47-3.12) at 30 days, 2.06% (95% CI 1.83-2.33) at 7 days and 1.36% (95% CI 1.15-1.59) at 2 days. Although we did not find statistically significant heterogeneity in SR among studies, those with a higher proportion of patients with motor weakness had a significantly higher risk of SR. No statistically significant association was observed between TIA clinic management and SR. Conclusion: The pooled early SR is lower than in previous meta-analyses and homogeneous for all studies with an urgent assessment and management strategy regardless of vascular risk factors and clinical characteristics. Therefore, the best setting for TIA management can be individualized for each center.

show abstract

Rapid assessment of transient ischaemic attack in a hospital with no on-call neurologist

Cited by 3 publications

References 33 publications

Risk of Subsequent Stroke Among Patients Receiving Outpatient vs Inpatient Care for Transient Ischemic Attack

Risk of Subsequent Stroke Among Patients Receiving Outpatient vs Inpatient Care for Transient Ischemic Attack

A 5-Decade Analysis of Incidence Trends of Ischemic Stroke After Transient Ischemic Attack

A Current Estimation of the Early Risk of Stroke after Transient Ischemic Attack: A Systematic Review and Meta-Analysis of Recent Intervention Studies

Contact Info

Product

Resources

About