title: Rapid assessment of transient ischaemic attack in a hospital with no on-call neurologist.
abstract: BACKGROUND
  Risk of stroke soon after a transient ischaemic attack (TIA) is high. Urgent care can reduce this risk. Our aim is to describe and evaluate the efficacy of rapid assessment of TIA patients in a hospital without a neurologist available 24 hours a day.
  
  
  METHODS
  In February 2007, we set up a protocol of rapid management of patients with symptoms consistent with acute TIA, with the aim of prioritising urgent care and reducing hospital admissions, without increasing risk of recurrences. We analyse our results since the protocol was implemented with particular focus on the analysis of delay in neurological and neurovascular assessment, percentage and reasons for hospitalisation, and stroke recurrence rates after 3 months.
  
  
  RESULTS
  Four hundred and eleven patients were studied, with a final diagnosis of TIA in 282 (68.6%). Among other diagnoses, the most frequent were a vasovagal reaction (5.6%) and confusional syndrome (4.6%). Delay between emergency arrival and neurovascular assessment was <24h in 82% of the cases, and <48 h in 93%. After neurological evaluation, 28.7% of the patients were immediately admitted to hospital (most common causes: severe stenosis of a large artery and crescendo TIA). The incidence of ischaemic stroke in TIA patients was 3.55% after 3 months and 70% of them suffered the recurrence within the first week after the initial TIA.
  
  
  CONCLUSIONS
  In a hospital without a neurologist available 24 hours a day, early assessment and management of TIA patients can be carried out in accordance with the guidelines, and may avoid hospitalisation in most cases without increasing recurrence rates.
authors: Servicio de Neurología, Hospital de Mataró, Mataró, Barcelona, España. Electronic address: epalomeras@csdm.cat.
authors: E
authors: E
authors: Palomeras Soler
authors: Servicio de Neurología, Hospital de Mataró, Mataró, Barcelona, España.
authors: P
authors: P
authors: Fossas Felip
authors: Servicio de Neurología, Hospital de Mataró, Mataró, Barcelona, España.
authors: A T
authors: AT
authors: Cano Orgaz
authors: Servicio de Neurología, Hospital de Mataró, Mataró, Barcelona, España.
authors: P
authors: P
authors: Sanz Cartagena
authors: Servicio de Neurología, Hospital de Mataró, Mataró, Barcelona, España.
authors: V
authors: V
authors: Casado Ruiz
authors: Servicio de Neurología, Hospital de Mataró, Mataró, Barcelona, España.
authors: D
authors: D
authors: Muriana Batista
mesh_terms: D000368:Aged; D019468:Disease Management; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000628:therapy; D008297:Male; D009460:Neurologic Examination / Q000379:methods*; D012008:Recurrence; D012307:Risk Factors; D020521:Stroke / Q000517:prevention & control; D000078329:Workforce
keywords: Ataque isquémico transitorio; Atención urgente; Gestión; Ictus; Management; Prognosis; Pronóstico; Recurrence; Recurrencia; Stroke; Transient ischaemic attack; Urgent care