title: How do we manage emergency department patients diagnosed with transient ischemic attack?
abstract: BACKGROUND
  Multiple studies have demonstrated low rates of antithrombotic use, low neuroimaging rates, and high subsequent risk of stroke at 90 days following an emergency department (ED) diagnosis of transient ischemic attack (TIA). This study assessed the use of antithrombotic medications, neuroimaging, and subsequent 90-day stroke rate for patients in a more recent cohort of ED patients discharged home with TIA.
  
  
  METHODS
  We conducted a 1-year historical cohort study of all patients discharged with a TIA at a tertiary care ED (census 60,000 visits/year), which was one of the four sites participating in one of the aforementioned studies. Data were extracted from paper and electronic records onto standardized data extraction forms. Clinical findings, medications, and tests were recorded.
  
  
  RESULTS
  A total of 211 patients were enrolled in the study. The patients had the following characteristics: the mean age was 71.2 years (SD 13.8 years), 56.9% were female, 53.1% had a history of hypertension, 26.5% had a history of ischemic heart disease, and 17.1% had a previous stroke. The most frequent neurologic deficit was unilateral weakness (53.6%), and most deficits lasted for more than 60 minutes (71.6%). Antithrombotic medications were used for 96.7% of patients at ED discharge. Neuroimaging was conducted in 94.3% of patients while in the ED. Our cohort had a 90-day stroke rate of 1.9%.
  
  
  CONCLUSIONS
  This study established that most TIA patients receive neuroimaging in the ED and are started on or maintained on antithrombotic agents. Clinicians are encouraged to ensure that electrocardiography is done routinely and to involve Neurology in follow-up care.
authors.affiliation: Department of Emergency Medicine, University of Ottawa, Canada. jperry@ohri.ca
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Perry
authors.forename: Jonathan
authors.initials: J
authors.lastname: Kerr
authors.forename: Cheryl
authors.initials: C
authors.lastname: Symington
authors.forename: Jane
authors.initials: J
authors.lastname: Sutherland
mesh_terms: D000368:Aged; D002170:Canada; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D004638:Emergency Treatment; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging / Q000379:methods; D010351:Patient Discharge / Q000706:statistics & numerical data; D018570:Risk Assessment; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D017749:Total Quality Management; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents