Rapid evaluation after high-risk TIA is associated with lower stroke risk.
BACKGROUND
Current 'standard of care' for patients presenting with a 'high-risk' TIA varies, with use of several outpatient and inpatient approaches. We describe the clinical outcomes and costs for high risk TIA patients who received care in a 'rapid evaluation unit', and compare these to a historical 'high-risk' cohort.


METHODS
The study cohort was comprised of patients with TIA admitted to a 'rapid evaluation unit' during the period March 2002 to April 2003. The comparison cohort was established by screening Calgary Health Region ER discharge records to identify all patients presenting with a diagnosis of TIA during the year 2000. A 'high-risk standard care cohort' was then identified based on the clinical admission criteria used to select patients for the rapid evaluation unit. Outcomes (stroke within 90 days, death) and costs were identified using chart review and provincial administrative data.


RESULTS
The early risk of stroke in the high risk standard care group (392 patients) was 9.7%, compared to 4.7% in the rapid evaluation cohort (189 patients) (p = 0.05). Median 1-year costs post TIA were CAN $8360 for patients in the rapid evaluation cohort, compared with CAN $4820 for patients in the high risk standard care group (p < 0.001).


CONCLUSIONS
The risk of early stroke was lower for patients in the rapid evaluation cohort compared to the high risk standard care cohort, suggesting that the use of rapid evaluation programs in patients with TIA at high risk of stroke may be beneficial, but incur greater costs over the course of the first year.
Wu
Caren M
CM
Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Manns
Braden J
BJ
Hill
Michael D
MD
Ghali
William A
WA
Donaldson
Cam
C
Buchan
Alastair M
AM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D038801:International Classification of Diseases; D002546:Ischemic Attack, Transient / Q000150:complications* / Q000175:diagnosis* / Q000191:economics / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000191:economics / Q000209:etiology* / Q000628:therapy; D055815:Young Adult