title: Implementation of a Community-Based Triage for Patients with Suspected Transient Ischemic Attack or Minor Stroke Study: A Prospective Multicenter Observational Study.
abstract: BACKGROUND
  Japan has the highest number of magnetic resonance imaging units in the world, and citizens can freely choose medical care at any hospital or clinic. We aimed to investigate the triage of patients with suspected transient ischemic attack (TIA) or minor stroke in this unique Japanese healthcare system.
  
  
  METHODS
  In this cohort study, patients with suspected TIA or minor stroke (National Institutes of Health Stroke Scale score <4) within 7 days after onset were prospectively enrolled and followed for 1 year. The high-risk group was defined as having at least one of the following 5 items at the initial visit: (1) atrial fibrillation, (2) carotid stenosis, (3) crescendo TIA, (4) definite focal brain symptoms, or (5) ABCD2 score of 4 or higher. After the initial assessment, the patients were diagnosed as having acute ischemic cerebrovascular syndrome (AICS) or stroke mimic. AICS was classified into 3 categories including definite, probable, and possible AICS, based on evidence of neurological deficits and brain infarction on the imaging study.
  
  
  RESULTS
  A total of 353 patients were enrolled and 89.8% of the patients were examined by diffusion-weighted imaging at the initial visit. Kaplan-Meier analyses demonstrated a statistically significant difference in subsequent stroke risk when the patients were triaged by the ABCD2 score (P = .031), 5-item high-risk categorization (P = .032), or AICS classification (P = .001).
  
  
  CONCLUSIONS
  This study demonstrates that hospitals and clinics with imaging facilities play a major role in triage and that the ABCD2 score, 5-item high-risk categorization, and AICS classification are useful as triage tools for patients with suspected TIA or minor stroke.
authors.affiliation: Taguchi Neurosurgery Clinic, Yokohama, Kanagawa, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Taguchi
authors.affiliation: Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan. Electronic address: shinnai@marianna-u.ac.jp.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Hasegawa
authors.affiliation: Bandoh Clinic, Yokohama, Kanagawa, Japan.
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Bandoh
authors.affiliation: Koyasu Neurosurgery Clinic, Yokohama, Kanagawa, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Koyasu
authors.affiliation: Watanabe Clinic, Yokohama, Kanagawa, Japan.
authors.forename: Yuukou
authors.initials: Y
authors.lastname: Watanabe
authors.affiliation: Kitakurihama Neurosurgery, Yokosuka, Kanagawa, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Yamashita
authors.affiliation: Saginuma Neurosurgery Clinic, Kawasaki, Kanagawa, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Shimazaki
authors.affiliation: Shima Neurosurgery and Orthopaedic Hospital, Kawasaki, Kanagawa, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shima
authors.affiliation: Miyakawa Internal Medicine and Pediatrics Clinic, Yokohama, Kanagawa, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Miyakawa
authors.affiliation: Niwa Medical Clinic, Yokohama, Kanagawa, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Niwa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D007564:Japan; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D014218:Triage
keywords: Transient ischemic attack; acute ischemic cerebrovascular syndrome; magnetic resonance imaging; minor stroke; triage