title: A transient ischaemic attack clinic with round-the-clock access (SOS-TIA): feasibility and effects.
abstract: BACKGROUND
  Diagnosis and treatment of cerebral and retinal transient ischaemic attacks (TIAs) are often delayed by the lack of immediate access to a dedicated TIA clinic. We evaluated the effects of rapid assessment of patients with TIA on clinical decision making, length of hospital stay, and subsequent stroke rates.
  
  
  METHODS
  We set up SOS-TIA, a hospital clinic with 24-h access. Patients were admitted if they had sudden retinal or cerebral focal symptoms judged to relate to ischaemia and if they made a total recovery. Assessment, which included neurological, arterial, and cardiac imaging, was within 4 h of admission. A leaflet about TIA with a toll-free telephone number for SOS-TIA was sent to 15 000 family doctors, cardiologists, neurologists, and ophthalmologists in Paris and its administrative region. Endpoints were stroke within 90 days, and stroke, myocardial infarction, and vascular death within 1 year.
  
  
  RESULTS
  Between January, 2003, and December, 2005, we admitted 1085 patients with suspected TIA; 574 (53%) were seen within 24 h of symptom onset. 701 (65%) patients had confirmed TIA or minor stroke, and 144 (13%) had possible TIA. 108 (17%) of the 643 patients with confirmed TIA had brain tissue damage. Median duration of symptoms was 15 min (IQR 5-75 min). Of the patients with confirmed or possible TIA, all started a stroke prevention programme, 43 (5%) had urgent carotid revascularisation, and 44 (5%) were treated for atrial fibrillation with anticoagulants. 808 (74%) of all patients seen were sent home on the same day. The 90-day stroke rate was 1.24% (95% CI 0.72-2.12), whereas the rate predicted from ABCD(2) scores was 5.96%.
  
  
  CONCLUSIONS
  Use of TIA clinics with 24-h access and immediate initiation of preventive treatment might greatly reduce length of hospital stay and risk of stroke compared with expected risk.
authors.affiliation: Department of Neurology and Stroke Centre, Bichat-Claude Bernard University Hospital, Denis Diderot University and Medical School-Paris VII, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Philippa C
authors.initials: PC
authors.lastname: Lavallée
authors.forename: Elena
authors.initials: E
authors.lastname: Meseguer
authors.forename: Halim
authors.initials: H
authors.lastname: Abboud
authors.forename: Lucie
authors.initials: L
authors.lastname: Cabrejo
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Olivot
authors.forename: Olivier
authors.initials: O
authors.lastname: Simon
authors.forename: Mikael
authors.initials: M
authors.lastname: Mazighi
authors.forename: Chantal
authors.initials: C
authors.lastname: Nifle
authors.forename: Philippe
authors.initials: P
authors.lastname: Niclot
authors.forename: Bertrand
authors.initials: B
authors.lastname: Lapergue
authors.forename: Isabelle F
authors.initials: IF
authors.lastname: Klein
authors.forename: Eric
authors.initials: E
authors.lastname: Brochet
authors.forename: Philippe Gabriel
authors.initials: PG
authors.lastname: Steg
authors.forename: Guy
authors.initials: G
authors.lastname: Lesèche
authors.forename: Julien
authors.initials: J
authors.lastname: Labreuche
authors.forename: Pierre-Jean
authors.initials: PJ
authors.lastname: Touboul
authors.forename: Pierre
authors.initials: P
authors.lastname: Amarenco
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D002340:Carotid Artery Diseases / Q000150:complications / Q000601:surgery; D002548:Cerebral Revascularization; D002940:Circadian Rhythm; D004632:Emergency Medical Services; D005240:Feasibility Studies; D006801:Humans; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000150:complications / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D009462:Neurology; D010044:Outpatient Clinics, Hospital; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D014057:Tomography, X-Ray Computed
chemical_list: D000925:Anticoagulants