TWO ACES

Abstract

Background and Purpose— To evaluate a novel emergency department-based TIA triage system. Methods— We developed an approach to TIA triage and management based on risk assessment using the ABCD 2 score in combination with early cervical and intracranial vessel imaging. It was anticipated that this triage system would avoid hospitalization for the majority of TIA patients and result in a low rate of recurrent stroke. We hypothesized that the subsequent stroke rate among consecutively encountered patients managed with this approach would be lower than predicted based on their ABCD 2 scores. Results— From June 2007 to December 2009, 224 consecutive patients evaluated in the Stanford emergency department for a possible TIA were enrolled in the study. One hundred fifty-seven were discharged to complete their evaluation at the outpatient TIA clinic; 67 patients were hospitalized. One hundred sixteen patients had a final diagnosis of TIA/minor stroke or possible TIA. The stroke rates at 7, 30, and 90 days were 0.6% (0.1%–3.5%) for patients referred to the TIA clinic and 1.5% (0.3%–8.0%) for the hospitalized patients. Combining both groups, the overall stroke rate was 0.9% (0.3%–3.2%), which is significantly less than expected based on ABCD 2 scores ( P =0.034 at 7 days and P =0.001 at 90 days). Conclusions— This emergency department-based inpatient versus outpatient TIA triage system led to a low rate of hospitalization (30%). Recurrent stroke rates were low for both the hospitalized and outpatient subgroups.