title: Monash transient ischemic attack triaging treatment: safety of a transient ischemic attack mechanism-based outpatient model of care.
abstract: OBJECTIVE
  Controversy surrounds the need for routine hospital admission for transient ischemic attack. The Monash Transient Ischemic Attack Triaging Treatment (M3T) model adopts rapid management in the emergency department followed by outpatient management prioritized by stroke mechanism. We compared safety and processes of care between M3T and the previous model of routine admission.
  
  
  METHODS
  Study cohorts consisted of patients managed with M3T (2004-2007) and the previous model (2003-2004). We determined 90-day stroke outcome using clinical and medical record review and data linkage to the population level state-wide hospital discharge morbidity database. We compared models of care using risk difference analysis, followed by logistic regression to adjust for previous indicators of risk. Secondary outcomes were proportions admitted, proportions undergoing carotid ultrasound, times to ultrasound and revascularization, and medication prescription.
  
  
  RESULTS
  In M3T (mean age, 64.7±14.7) 85/488 (17.4%) patients were admitted compared with 117/169 (62.9%) in the previous model (mean age, 72.5±13.9). With near-complete follow-up, 90-day stroke outcome was 1.50% (95% confidence interval, 0.73%-3.05%) in M3T and 4.67% (95% confidence interval, 2.28%-9.32%) in the previous model (P=0.03). Compared with the previous model, the adjusted odds ratio of stroke for M3T was 0.46 (95% confidence interval, 0.12-1.68; P=0.24). M3T was associated with greater proportions undergoing carotid ultrasound (P<0.001) and receiving antiplatelet therapy (P=0.005).
  
  
  CONCLUSIONS
  The M3T system was associated with low 90-day stroke outcome in transient ischemic attack patients, providing proof of concept that these patients may be managed safely without routine hospital admission using a closely supervised protocol in the emergency department.
authors.affiliation: Stroke and Aging Research Center, Department of Medicine, Southern Clinical School, Monash University, Level 5, E Block, Monash Medical Centre, Clayton Road, Clayton 3169, Victoria, Australia.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Sanders
authors.forename: Velandai K
authors.initials: VK
authors.lastname: Srikanth
authors.forename: Damien J
authors.initials: DJ
authors.lastname: Jolley
authors.forename: Vijaya
authors.initials: V
authors.lastname: Sundararajan
authors.forename: Helen
authors.initials: H
authors.lastname: Psihogios
authors.forename: Kitty
authors.initials: K
authors.lastname: Wong
authors.forename: David
authors.initials: D
authors.lastname: Ramsay
authors.forename: Thanh G
authors.initials: TG
authors.lastname: Phan
mesh_terms: D000368:Aged; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D015331:Cohort Studies; D003955:Diagnostic Tests, Routine; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D020521:Stroke / Q000453:epidemiology; D014218:Triage / Q000379:methods*; D014463:Ultrasonography
chemical_list: D010975:Platelet Aggregation Inhibitors