title: Temporal Trends in the Use of Investigations After Stroke or Transient Ischemic Attack.
abstract: BACKGROUND
  Guidelines recommend that patients with stroke or transient ischemic attack (TIA) undergo neuroimaging and cardiac investigations to determine etiology and guide treatment. It is not known how the use of these investigations has changed over time and whether there have been associated changes in management.
  
  
  OBJECTIVE
  To evaluate temporal trends in the use of brain and vascular imaging, echocardiography, and antithrombotic and surgical therapy after stroke or TIA.
  
  
  METHODS
  We analyzed 42,738 patients with stroke or TIA presenting to any of the 11 regional stroke centers in Ontario, Canada between 2003 and 2012 using the Ontario Stroke Registry database. The study period was divided into 1-year intervals and we used the Cochran-Armitage test to determine trends over time.
  
  
  RESULTS
  Between 2003/2004 and 2011/2012, the proportion of patients undergoing brain imaging increased from 96% to 99%, as did the proportion receiving ≥3 brain scans (21%-39%), magnetic resonance imaging (13%-50%), vascular imaging (62%-88%), or echocardiography (52%-70%) (P<0.0001 for all comparisons). There was an increase in the proportion receiving any antithrombotic therapy (83%-91%, P<0.0001) but no change in use of anticoagulation (25% overall and 68% in subgroup with atrial fibrillation) or carotid revascularization (1.4%-1.5%, P=0.49).
  
  
  CONCLUSIONS
  The use of investigations after stroke has increased over time without concomitant changes in medical or surgical management. Although initial neurovascular imaging is in accordance with practice guidelines, the use of multiple imaging procedures and routine echocardiography are of uncertain clinical effectiveness.
authors.affiliation: *Department of Medicine, University of Toronto †Centre for Research on Inner City Health, Division of General Internal Medicine, Li KaShing Knowledge Institute, St Michael's Hospital ‡Institute of Health Policy, Management and Evaluation, University of Toronto §Institute for Clinical Evaluative Sciences ∥Department of Medical Imaging, University of Toronto ¶Sunnybrook Research Institute, Sunnybrook Health Sciences Centre #Division of General Internal Medicine, Toronto General Research Institute, University Health Network, Toronto, ON, Canada.
authors.forename: Vivian T
authors.initials: VT
authors.lastname: Ng
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Bayoumi
authors.forename: Jiming
authors.initials: J
authors.lastname: Fang
authors.forename: Kirsteen R
authors.initials: KR
authors.lastname: Burton
authors.forename: Melissa
authors.initials: M
authors.lastname: Stamplecoski
authors.forename: Jodi D
authors.initials: JD
authors.lastname: Edwards
authors.forename: Moira K
authors.initials: MK
authors.lastname: Kapral
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002548:Cerebral Revascularization / Q000706:statistics & numerical data; D003952:Diagnostic Imaging / Q000379:methods* / Q000706:statistics & numerical data*; D004452:Echocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D019983:Guideline Adherence; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D009864:Ontario; D017410:Practice Guidelines as Topic; D020521:Stroke / Q000175:diagnosis* / Q000628:therapy*
chemical_list: D005343:Fibrinolytic Agents