Urgent neurology consultation from the ED for transient ischemic attack.
OBJECTIVE
The objective of this study was to evaluate the association between urgent neurology consultation and outcomes for patients with transient ischemic attack (TIA).


METHODS
In a secondary analysis of data from 1707 emergency department patients with transient ischemic attack from March 1997 to May 1998, we compared presentation, management, and outcomes by neurology consultation status using generalized estimating equations to adjust for ABCD(2) score and clustering by facility and survival analysis for outcomes.


RESULTS
Consultation was obtained f28% of patients. Median ABCD(2) scores were comparable, but consultation was associated with hospital admission (odds ratio, 1.35 [1.02-1.78], P = .04) and use of antithrombotics (odds ratio, 1.88 [1.20-2.93], P = .005). The cumulative stroke risk was significantly lower within 1 week (5.3% versus 7.5%, P = .02) but not at 90 days (9.9% versus 11.0%, P = .21).


CONCLUSIONS
Consultation was not targeted to high-risk patients but was associated with some quality of care measures and improved early outcomes; however, improvement in 90-day outcomes was not established.
Kim
Anthony S
AS
Department of Neurology, University of California, San Francisco, 94143-0114, USA. akim@ucsf.edu
Sidney
Stephen
S
Bernstein
Allan L
AL
Douglas
Vanja C
VC
Johnston
S Claiborne
SC
D000368:Aged; D003657:Decision Making; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D009462:Neurology; D012017:Referral and Consultation; D018570:Risk Assessment; D012307:Risk Factors; D018709:Statistics, Nonparametric; D016019:Survival Analysis
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