Emergency department evaluation of ischemic stroke and TIA: the BASIC Project.
OBJECTIVE
To identify demographic and clinical variables of emergency department (ED) practices in a community-based acute stroke study.


METHODS
By both active and passive surveillance, the authors identified cerebrovascular disease cases in Nueces County, TX, as part of the Brain Attack Surveillance in Corpus Christi (BASIC) Project, a population-based stroke surveillance study, between January 1, 2000, and December 31, 2002. With use of multivariable logistic regression, variables independently associated with three separate outcomes were sought: hospital admission, brain imaging in the ED, and neurologist consultation in the ED. Prespecified variables included age, sex, ethnicity, insurance status, NIH Stroke Scale score, type of stroke (ischemic stroke or TIA), vascular risk factors, and symptom presentation variables. Percentage use of recombinant tissue plasminogen activator (rt-PA) was calculated.


RESULTS
A total of 941 Mexican Americans (MAs) and 855 non-Hispanic whites (NHWs) were seen for ischemic stroke (66%) or TIA (34%). Only 8% of patients received an in-person neurology consultation in the ED, and 12% did not receive any head imaging. TIA was negatively associated with neurology consultations compared with completed stroke (odds ratio [OR] 0.35 [95% CI 0.21 to 0.57]). TIA (OR 0.14 [0.10 to 0.19]) and sensory symptoms (OR 0.59 [0.44 to 0.81]) were also negatively associated with hospital admission. MAs (OR 0.58 [0.35 to 0.98]) were less likely to have neurology consultations in the ED than NHWs. Only 1.7% of patients were treated with rt-PA.


CONCLUSIONS
Neurologists are seldom involved with acute cerebrovascular care in the emergency department (ED), especially in patients with TIA. Greater neurologist involvement may improve acute stroke diagnosis and treatment efforts in the ED.
Brown
D L
DL
Stroke Program, University of Michigan ,Health System, Ann Arbor, USA.
Lisabeth
L D
LD
Garcia
N M
NM
Smith
M A
MA
Morgenstern
L B
LB
D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis* / Q000188:drug therapy / Q000208:ethnology; D019090:Case Management / Q000706:statistics & numerical data*; D015897:Comorbidity; D003952:Diagnostic Imaging / Q000706:statistics & numerical data*; D018450:Disease Progression; D042241:Early Diagnosis; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000188:drug therapy / Q000208:ethnology; D008297:Male; D017058:Mexican Americans; D009462:Neurology; D010343:Patient Admission / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000706:statistics & numerical data*; D011994:Recombinant Proteins / Q000627:therapeutic use; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012307:Risk Factors; D013781:Texas / Q000453:epidemiology; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome; D044465:White People
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator