title: Referral pathways for patients with TIA avoiding hospital admission: a scoping review.
abstract: To identify the features and effects of a pathway for emergency assessment and referral of patients with suspected transient ischaemic attack (TIA) in order to avoid admission to hospital.
  
  
  
  Scoping review.
  
  
  
  PubMed, CINAHL Web of Science, Scopus.
  
  
  
  Reports of primary research on referral of patients with suspected TIA directly to specialist outpatient services.
  
  
  
  We screened studies for eligibility and extracted data from relevant studies. Data were analysed to describe setting, assessment and referral processes, treatment, implementation and outcomes.
  
  
  
  8 international studies were identified, mostly cohort designs. 4 pathways were used by family doctors and 3 pathways by emergency department physicians. No pathways used by paramedics were found. Referrals were made to specialist clinic either directly or via a 24-hour helpline. Practitioners identified TIA symptoms and risk of further events using a checklist including the ABCD2 tool or clinical assessment. Antiplatelet medication was often given, usually aspirin unless contraindicated. Some patients underwent tests before referral and discharge. 5 studies reported reduced incident of stroke at 90 days, from 6-10% predicted rate to 1.3-2.1% actual rate. Between 44% and 83% of suspected TIA cases in these studies were referred through the pathways.
  
  
  
  Research literature has focused on assessment and referral by family doctors and ED physicians to reduce hospitalisation of patients with TIA. No pathways for paramedical use were reported. We will use results of this scoping review to inform development of a paramedical referral pathway to be tested in a feasibility trial.
  
  
  
  ISRCTN85516498. Stage: pre-results.
authors.affiliation: Swansea University Medical School, Swansea, UK.
authors.forename: Bridie Angela
authors.initials: BA
authors.lastname: Evans
authors.affiliation: Brighton and Sussex Medical School, Brighton, UK.
authors.forename: Khalid
authors.initials: K
authors.lastname: Ali
authors.affiliation: Swansea University Medical School, Swansea, UK.
authors.forename: Jenna
authors.initials: J
authors.lastname: Bulger
authors.affiliation: Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
authors.forename: Gary A
authors.initials: GA
authors.lastname: Ford
authors.affiliation: Swansea University Medical School, Swansea, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Jones
authors.affiliation: Welsh Ambulance Service NHS Trust, Swansea, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Moore
authors.affiliation: Swansea University Medical School, Swansea, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Porter
authors.affiliation: Lay Contributor c/o Swansea University Medical School, Swansea, UK.
authors.forename: Alan David
authors.initials: AD
authors.lastname: Pryce
authors.affiliation: Kingston University and St George's, University of London, London, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Quinn
authors.affiliation: Swansea University Medical School, Swansea, UK.
authors.forename: Anne C
authors.initials: AC
authors.lastname: Seagrove
authors.affiliation: Swansea University Medical School, Swansea, UK.
authors.forename: Helen
authors.identifier: 0000-0003-0173-8843
authors.initials: H
authors.lastname: Snooks
authors.affiliation: Lay Contributor c/o Swansea University Medical School, Swansea, UK.
authors.forename: Shirley
authors.initials: S
authors.lastname: Whitman
authors.affiliation: Welsh Ambulance Service NHS Trust, Swansea, UK.
authors.forename: Nigel
authors.initials: N
authors.lastname: Rees
mesh_terms: D000553:Ambulatory Care; D057189:Checklist; D019091:Critical Pathways; D004636:Emergency Service, Hospital; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000188:drug therapy; D010343:Patient Admission; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012017:Referral and Consultation
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: Alternative pathways; Prehospital emergency care; Scoping review; Transient Ischaemic Attack