title: Emergency Department Management of Transient Ischemic Attack: A Survey of Emergency Physicians.
abstract: BACKGROUND
  Patients are at high risk for stroke following a transient ischemic attack (TIA). The ideal setting for evaluating and treating patients with TIA has not been established, resulting in variability in emergency department (ED) TIA management. We conducted a survey to describe ED TIA management and factors that influence disposition determination for TIA patients.
  
  
  METHODS
  We administered a mail survey to 480 randomly selected members of the Michigan College of Emergency Physicians. Survey questions addressed current ED TIA management, the acceptability of the ABCD(2) risk-stratification tool, and disposition recommendations for a series of hypothetical TIA patients.
  
  
  RESULTS
  A total of 188 (39%) responses were received. Head computed tomography (96.2%) and antiplatelet therapy (88.2%) were the most commonly reported ED interventions. Over 85% of respondents reported admitting most or all TIA patients. The ABCD(2) score had low acceptability among emergency medicine physicians and was rarely incorporated into practice (10.7%). Respondents identified a short-term risk of stroke of less than 2% (95% confidence interval: 1.6-2.4) as an acceptable threshold for discharge; however, most respondents recommended admission even for low-risk TIA patients. Those with access to an outpatient TIA clinic were less likely to admit low-risk TIA patients; those with access to an observation unit were more likely to admit.
  
  
  CONCLUSIONS
  In this survey, ED physicians preferred hospital admission for most TIA patients, including those at low risk for stroke. The ABCD(2) risk-stratification tool had low acceptability. Further research is needed to refine risk-stratification tools and define the optimal setting for TIA evaluations.
authors.affiliation: Department of Emergency Medicine, College of Human Medicine, Michigan State University, Grand Rapids, Michigan. Electronic address: oostema@msu.edu.
authors.forename: J Adam
authors.initials: JA
authors.lastname: Oostema
authors.affiliation: Department of Emergency Medicine, College of Human Medicine, Michigan State University, Grand Rapids, Michigan.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Brown
authors.affiliation: Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan.
authors.forename: Mathew
authors.initials: M
authors.lastname: Reeves
mesh_terms: D000328:Adult; D002533:Cerebral Angiography / Q000379:methods; D000072226:Computed Tomography Angiography; D003661:Decision Support Techniques; D004632:Emergency Medical Services / Q000639:trends*; D005260:Female; D019538:Health Care Surveys; D020445:Hospitalists / Q000639:trends*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008824:Michigan; D008875:Middle Aged; D010343:Patient Admission / Q000639:trends*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians' / Q000639:trends*; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: ABCD(2); Transient ischemic attack (TIA); clinical prediction rule; emergency department; survey