Long term evolution of patients treated in a TIA unit

International Archives of Medicine

Carlos H Lahoz¹  Julio Pascual¹  Gerard Mauri¹  Juan Vega¹  Davinia Larrosa¹  Sergio Calleja¹  Lorena Benavente¹ 

[1] Neurology Department, University Hospital “Central de Asturias”, C/Julián Clavería s/n, 33006, Oviedo, Spain

关键词: TIA management;    Stroke care models;    TIA unit;    Mild stroke;    TIA;   

Others  :  803190
DOI  :  10.1186/1755-7682-6-19

 received in 2013-01-02, accepted in 2013-04-13,  发布年份 2013

【 摘 要 】

Background

Transient ischemic attacks (TIA) entail a high risk of stroke recurrence, which depends on the etiology. New organizational models have been created, but there is not much information about the long-term evolution of patients managed according to these premises. Our aim is to refer the follow-up of patients attended according to our model of TIA Unit.

Methods

TIA Unit is located in the Emergency Department and staffed by vascular neurologists. Patients admitted during the Neurology night shift stayed in such Unit <48h with complete etiological study. Preventive treatment is instituted in patients discharged to a high resolution Neurology consult, in order to review in <2 weeks and subsequent follow-up.

Results

During a year 161 patients were attended, being admitted to the hospital 8.6%. A total of 1470 hospital days were avoided. Recurrence at 90 days was of 0.6%. Mean follow-up was 18.14 ± 8.02 months (0–34), total recurrence 6.2% (70% cardioembolic strokes). There were no complications derived from treatment. Cardiological events were recorded in 10.6%, neoplastic in 5%, cognitive impairment in 11%. There were 3 deaths unrelated nor to the stroke or its treatment.

Conclusions

This model allows an early diagnosis and treatment of TIA, preventing recurrences of stroke in a long term. It detects atherothrombotic strokes, most of them admitted to the hospital, and it shows a greater difficulty for detecting all cardioembolic strokes. TIA Unit appeared to be safe in using anticoagulation therapy, as the follow-up shows. It shows the same quality of management than hospital admission, with a significant saving in hospital stays.

【 授权许可】

   
2013 Benavente et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Greer M: Current concepts in managing TIAs and stroke. Geriatrics 1979, 34(Suppl 4):53-59.
• [2]Caronna JJ: Transient ischemic attacks: pathophysiology and medical management. Postgrad Med 1976, 59(Suppl 3):106-111.
• [3]Hackam DG, Spence JD: Combining multiple approaches for the secondary prevention of vascular events after stroke: a quantitative modelling study. Stroke 2007, 38:1881-1885.
• [4]Hörer S, Schulte-Altedorneburg G, Haberl RL: Management of patients with transient ischemic attack is safe in an outpatient clinic based on rapid diagnosis and risk stratification. Cerebrovasc Dis 2011, 32:504-510.
• [5]Servicio de Salud del Principado de Asturias: Consejería de Salud y Servicios Sanitarios. 2010. [Memoria] D.L.: AS-1.783/2003
• [6]Albucher JF, Martel P, Mas JL: Clinical practice guidelines: diagnosis and immediate management of transient ischemic attacks in adults. Cerebrovasc Dis 2005, 20:220-225.
• [7]Sacco RL, Adams R, Albers G, et al.: Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack. A statement for healthcare professionals from the American Heart Association/American Stroke Association Council on stroke: Co-sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline. Stroke 2006, 37:577-617.
• [8]Ringleb PA, Bousser MG, Ford G, Bath PH, Brainin M, Caso V, Cervera A, Chamorro A, Cordonnier CH, Csiba L, Davalos A, Diener HCH, Ferro J, Hacke W, Hennerici M, Kaste M, Langhorne P, Lees K, Leys D, Lodder J, Markus HS, Mas JL, Mattle HP, Muir K, Norrving B, Obach V, Paolucci S, Ringelstein B, Schellinger PD, Sivenius J, Skvortsova V, Sunnerhagen KS, Thomassen L, Toni D, Kummer R, Wahlgren NG, Walker MF, Wardlaw J: Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. The European Stroke Organization (ESO) executive committee and the ESO writing committee. Cerebrovasc Dis 2008, 25(5):457-507.
• [9]Furie KL, Kasner SE, Adams RJ, Albers GW, Bush RL, Fagan SC, Halperin JL, Johnston SC, Katzan I, Kernan WN, Mitchell PH, Ovbiagele B, Palesch YY, Sacco RL, Schwamm LH, Wassertheil-Smoller S, Turan TN, Wentworth D, on behalf of the American heart Association Stroke Council, Council on cardiovascular Nursing, Council on Clinical Cardiology, and Interdisciplinary Council on Quality of Care an Outcomes Research: Stroke. 42:227-276.
• [10]Adams HP Jr, Bendixen BH, Kappelle LJ, et al.: Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993, 24(Suppl 1):35-41.
• [11]Rothwell PM, Warlow CP: Timing of TIAs preceding stroke: time window for prevention is very short. Neurology 2005, 64:517-820.
• [12]Johnston SC, Smith WS: Practice variability in management of transient ischemic attacks. Eur Neurol 1999, 42:105-108.
• [13]Goldstein IB, Bian J, Bonito AJ, et al.: New transient ischemic attack and stroke: outpatient management by primary care physicians. Arch Intern Med 2000, 160:2941-2946.
• [14]Johnston SC, Gress DR, Browner WS, et al.: Short-term prognosis after emergency department diagnosis of TIA. JAMA 2000, 284:2901-2906.
• [15]Lovett JK, Dennis MS, Sandercock PA, et al.: Very early risk of stroke after a first transient ischemic attack. Stroke 2003, 34:138-140.
• [16]Johnston SC, Rothwell PM, Nguyen-Huynh MN, et al.: Validation and refinement of scores to predict very early stroke risk after transient ischemic attack. Lancet 2007, 369:283-292.
• [17]Rothwell PM, Giles MF, Chandratheva A, on behalf of the Early use of Existing Preventive Strategies for Stroke (EXPRESS) study, et al.: Effect of urgent treatment of transient ischemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison. Lancet 2007, 370:1432-1442.
• [18]Coull A, Lovett JK, Rothwell PM, on behalf of the Oxford Vascular Study: Population based study of early risk of stroke after a transient attack or minor stroke: implications for public education and organisation of services. BMJ 2004, 328:326-328.
• [19]Coull A, Rothwell PM: Under-estimation of the early risk of recurrence after first stroke by the use of restricted definitions. Stroke 2004, 35:1925-1929.
• [20]Lavallé PC, Meseguer E, Abboud H, et al.: A transient ischemic attack clinic with round-the-clock access (SOS-TIA): feasibility and effects. Lancet Neurol 2007, 6:953-960.
• [21]Petty GW, Brown RD Jr, Whisnant JP, et al.: Ischemic stroke subtypes: a population-based study of functional outcome, survival, and recurrence. Stroke 2000, 31(Suppl 5):1062-1068.
• [22]Koudstaal PJ, van Gijn J, Staal A: Diagnosis of transient ischemic attacks: Improvement of interobserver agreement by a check-list in ordinary language. Stroke 1986, 17:723-728.
• [23]Fisher CM: Perspective: transient ischemic attacks. N Engl J Med 2002, 347:1642-1644.
• [24]Murray S, Bashir K, Lees KR, et al.: Epidemiological aspects of referral to TIA clinics in Glasgow. Scout Med J 2007, 52(Suppl 1):4-8.
• [25]Quinn TJ, Cameron AC, Dawson J, et al.: ABCD2 scores and prediction of noncerebrovascular diagnoses in an outpatient population: a case-control study. Stroke 2009, 40(Suppl 3):749-753.
• [26]Norris JW, Hachinski VC: Misdiagnosis of stroke. Lancet 1982, 1:328-331.
• [27]Libman RB, Wirkowski E, Alvir J, et al.: Conditions that mimic stroke in the emergency department. Implications for acute stroke trials. Arch Neurol 1995, 52:1119-1122.
• [28]Kothari RU, Brott T, Broderick JP, et al.: Emergency physicians: accuracy in diagnosis of stroke. Stroke 1995, 26:2238-2241.
• [29]Ay H, Buonanno FS, Rordorf G, et al.: Normal diffusion-weighted MRI during stroke-like deficits. Nerurology 1999, 52:1784-1792.
• [30]Prabhakaran S, Silver AJ, Warrior L, et al.: Misdiagnosis of transient ischemic attacks in the emergency room. Cerebrovasc Dis 2008, 26:630-635.
• [31]Zhang YY, Cordato D, Shen Q, et al.: Risk factor, pattern, etiology and outcome inischemic stroke patients with cancer: a nested case-control study. Cerebrovasc Dis 2007, 23(Suppl 2–3):181-187.
• [32]Katz MJ, Lipton RB, Hall CB, et al.: Age-specific and sex-specific prevalence and incidente of mild cognitive impairment, dementia and Alzheimer dementia in blacks and whites: a report from the Einsteing Aging Study. Alzheimer Dis Assoc Disord 2012, 26(4):335-343.
• [33]Luengo-Fernández R, Gray AM, Rothwell PM: Effect of urgent treatment for transient ischemic attack and minor stroke on disability and hospital costs (EXPRESS study): a prospective population-based sequential comparison. Lancet Neurol 2009, 8:235-243.
• [34]Kamel H, Fahimi J, Govindarajan P, Navi BB: Nationwide patterns of hospitalization after transient ischemic attack. J Stroke Cerebrovasc Dis 2012. Nov 10. In press