title: Emergency physicians' management of transient ischemic attack and desired sensitivity of a clinical decision rule for stroke in three countries.
abstract: OBJECTIVE
  Four to 10% of patients with transient ischemic attack (TIA) suffer a stroke or die within 7 days. Our objectives were to determine (1) current practice for investigating and treating emergency department (ED) patients with TIA, (2) willingness to use a clinical decision rule to identify patients at high risk of impending stroke or death, and (3) the required sensitivity of this rule.
  
  
  METHODS
  We administered a mail survey to a random sample of members of three national emergency physician associations in Australia, Canada, and the United States using a modified Dillman technique. A prenotification letter and up to three surveys were sent.
  
  
  RESULTS
  A total of 801 responses (53.7%) from 1,493 surveys were received; 53.6% (95% CI 47.5-59.7) of emergency physicians reported routinely admitting TIA patients, ranging from 6.6% in Canada to 56.7% in the United States, and 9.9% of emergency physicians have a stroke prevention clinic, with 4.7% estimating that patients are seen within 7 days. A sensitive clinical decision rule for TIA patients would be used by 96.3% (95% CI 93.9-98.7) of emergency physicians. The median required sensitivity of this rule for stroke or death within 7 days was 97%.
  
  
  CONCLUSIONS
  Almost half of all TIA patients are managed as outpatients, which is neither expedited nor in a dedicated stroke clinic. Emergency physicians indicate a willingness to use a highly sensitive clinical decision rule to triage TIA patients.
authors.affiliation: Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada. jperry@ohri.ca
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Perry
authors.forename: Reena
authors.initials: R
authors.lastname: Goindi
authors.forename: Jamie
authors.initials: J
authors.lastname: Brehaut
authors.forename: Monica
authors.initials: M
authors.lastname: Taljaard
authors.forename: Sandra
authors.initials: S
authors.lastname: Schneider
authors.forename: Ian G
authors.initials: IG
authors.lastname: Stiell
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia; D002170:Canada; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000628:therapy; D014481:United States