Evaluation of transient ischemic attack in an emergency department observation unit.
OBJECTIVE
To evaluate the feasibility of a protocol for evaluation of transient ischemic attack (TIA) in an Emergency Department Observation Unit (EDOU), and assess the risk of early stroke after such an evaluation.


METHODS
All adult patients presenting to the Emergency Department (ED) with signs and symptoms consistent with TIA were prospectively enrolled in this observational study over a period of 3 years. Patients underwent a standardized TIA evaluation per protocol. Risk of subsequent stroke at 48 h, 1 week, 1 month, and 3 months was prospectively assessed.


RESULTS
In total, 418 patients were seen during the study period, and all were evaluated per the EDOU TIA protocol. The mean age was 73.1 (+/-13.3) years and 53.8% were males. Comorbidities included hypertension in 71.5%, diabetes mellitus in 20.1%, prior TIA in 19.6%, and prior ischemic stroke in 19.6% of the cohort. Brain CT, neurology consult, electrocardiogram, carotid ultrasound, and additional tests were performed, and education was given. A total of 30.4% of the patients were dismissed directly from the EDOU. The risk of stroke at 2 days was 0.96%, at 7 days 1.2%, at 30 days 1.9%, and 2.4% at 90 days.


CONCLUSIONS
An Emergency Department Observation Unit Protocol for TIA is a feasible option for expedited evaluation of these patients.
Stead
Latha G
LG
Department of Emergency Medicine, Division of Research, Mayo Clinic College of Medicine, Generose G-410, 200 First Street SW, Rochester, MN 55905, USA. stead.latha@mayo.edu
Bellolio
M Fernanda
MF
Suravaram
Smitha
S
Brown
Robert D
RD
Bhagra
Anjali
A
Gilmore
Rachel M
RM
Boie
Eric T
ET
Decker
Wyatt W
WW
D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D019091:Critical Pathways; D003920:Diabetes Mellitus / Q000453:epidemiology; D042241:Early Diagnosis; D004632:Emergency Medical Services / Q000379:methods* / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control