Jennifer L. Wiler, MD, MBA, FACEP reviewing Kapral MK et al. Neurology 2016 Apr 26.

For patients who are discharged, outcomes are better when they are referred for follow-up specialty care.

Transient ischemic attacks (TIAs) can lead to subsequent stroke within 90 days in an estimated 10% to 20% of cases. Current guidelines recommend prompt testing for stroke risk factors including hypercholesterolemia, carotid stenosis, and atrial fibrillation. Using data from the Ontario Stroke Registry for 8540 adult patients with an emergency department (ED) diagnosis of TIA or minor stroke, researchers compared outcomes and adherence to recommended care between those admitted to the hospital (usual care) and those discharged from the ED, either with referral to a specialized stroke-prevention clinic or with no follow-up care plan.

Overall, 47% of patients were admitted, 36% were discharged from the ED with referral, and 17% were discharged without referral. Compared with admitted patients, the discharged cohort was significantly less likely to receive recommended tests and treatments (e.g., brain imaging, arrhythmia monitoring, antithrombotic therapy). After risk adjustment, 1-year stroke case fatality rates were similar between the admitted and discharged cohorts (adjusted hazard ratio, 1.11); however, rates of readmission or repeat ED visits were lower in the admitted cohort (AHR, 0.52). Among discharged patients, those referred for specialty care follow-up had lower mortality risk (AHR, 0.49).

Citation(s):

Kapral MK et al. Association between hospitalization and care after transient ischemic attack or minor stroke. Neurology 2016 Apr 26; 86:1582.

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