title: Yield of ultra-rapid carotid ultrasound and stroke specialist assessment in patients with TIA and minor stroke: an Italian TIA service audit.
abstract: In Italy the vast majority of TIA and minor strokes are seen in the A&E. Early diagnosis and management of TIA and minor stroke in this setting is habitually difficult and often lead to cost-ineffective hospital admissions. We set up an ultra-rapid TIA service run by neurovascular physicians based on early specialist assessment and ultrasound vascular imaging. We audit the clinical effectiveness and feasibility of the service and the impact of this service on TIA and minor strokes hospital admissions. We compared the rate of TIA and minor stroke admissions/discharges in the year before (T0) and in the year during which the TIA service was operating (T1). At T1 57 patients had specialist evaluation and 51 (89.5 %) of them were discharged home. Two (3.5 %) patients had recurrent symptoms after discharge. Seven had a pathological carotid Doppler ultrasound. Four of them had hospital admission and subsequent carotid endoarterectomy within a week. Taking the whole neurology department into consideration at T1 there was a 30-41 % reduction in discharges of patients with TIA or minor stroke. Taking the stroke unit section into consideration at T1 there was a 25 % reduction in admissions of patients with NIHSS score <4 and 40 % reduction in admissions of patients with Barthel Index above 80. The model of TIA service we implemented based on ultra-rapid stroke physician assessment and carotid ultrasound investigation is feasible and clinically valid. Indirect evidence suggests that it reduced the rate of expensive TIA/minor stroke hospital admissions.
authors.affiliation: Department of Neuroscience, Unit of Neurology, UOC Neurologia, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata Verona, Piazzale A.Stefani 1, 37126, Verona, Italy, ggulli@sgul.ac.uk.
authors.forename: Giosuè
authors.initials: G
authors.lastname: Gulli
authors.forename: Elisa
authors.initials: E
authors.lastname: Peron
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ricci
authors.forename: Eva
authors.initials: E
authors.lastname: Formaglio
authors.forename: Nicola
authors.initials: N
authors.lastname: Micheletti
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Tomelleri
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Moretto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D054869:Clinical Audit; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging*; D007558:Italy; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D012720:Severity of Illness Index; D020521:Stroke / Q000000981:diagnostic imaging*; D013997:Time Factors; D018616:Ultrasonography, Doppler, Duplex; D014711:Vertebral Artery; D055815:Young Adult
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