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Emergency physicians’ management of transient ischemic attack and desired sensitivity of a clinical decision rule for stroke in three countries

Published online by Cambridge University Press:  11 May 2015

Jeffrey J. Perry ,
Reena Goindi ,
Jamie Brehaut ,
Monica Taljaard ,
Sandra Schneider  and
Ian G. Stiell
Jeffrey J. Perry*
Affiliation:
Department of Emergency Medicine, Department of Epidemiology and Community Medicine, Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
Reena Goindi
Affiliation:
Department of Emergency Medicine, Department of Epidemiology and Community Medicine, Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
Jamie Brehaut
Affiliation:
Department of Emergency Medicine, Department of Epidemiology and Community Medicine, Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
Monica Taljaard
Affiliation:
Department of Emergency Medicine, Department of Epidemiology and Community Medicine, Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
Sandra Schneider
Affiliation:
Department of Emergency Medicine, University of Rochester, Rochester, NY
Ian G. Stiell
Affiliation:
Department of Emergency Medicine, Department of Epidemiology and Community Medicine, Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
*
Clinical Epidemiology Unit, F6, Ottawa Hospital Research Institute, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, ON K1Y 4E9; jperry@ohri.ca

Abstract

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Objective:

Four to 10% of patients with transient ischemic attack (TIA) suffer a stroke or die within 7 days. Our objectives were to determine (1) current practice for investigating and treating emergency department (ED) patients with TIA, (2) willingness to use a clinical decision rule to identify patients at high risk of impending stroke or death, and (3) the required sensitivity of this rule.

Methods:

We administered a mail survey to a random sample of members of three national emergency physician associations in Australia, Canada, and the United States using a modified Dillman technique. A prenotification letter and up to three surveys were sent.

Results:

A total of 801 responses (53.7%) from 1,493 surveys were received; 53.6% (95% CI 47.5–59.7) of emergency physicians reported routinely admitting TIA patients, ranging from 6.6% in Canada to 56.7% in the United States, and 9.9% of emergency physicians have a stroke prevention clinic, with 4.7% estimating that patients are seen within 7 days. A sensitive clinical decision rule for TIA patients would be used by 96.3% (95% CI 93.9–98.7) of emergency physicians. The median required sensitivity of this rule for stroke or death within 7 days was 97%.

Conclusions:

Almost half of all TIA patients are managed as outpatients,which is neither expedited nor in a dedicated stroke clinic. Emergency physicians indicate a willingness to use a highly sensitive clinical decision rule to triage TIA patients.

Keywords

clinical decision rulestransient ischemic attack (TIA)
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 13 , Issue 1 , January 2011 , pp. 19 - 27
Copyright
Copyright © Canadian Association of Emergency Physicians 2011

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