Skip to main content Accessibility help
×
Home

Predictors of Hospitalization in Patients With Transient Ischemic Attack or Minor Ischemic Stroke

  • Moira K. Kapral (a1) (a2) (a3) (a4) (a5), Ruth Hall (a1) (a3), Jiming Fang (a1), Peter C. Austin (a1) (a3) (a5), Frank L. Silver (a1) (a2) (a6), Leanne K. Casaubon (a2), David J. Gladstone (a1) (a2) (a5) (a7), Melissa Stamplecoski (a1) and Jack V. Tu (a1) (a2) (a3) (a5) (a8)...

Abstract

Background: Transient ischemic attack (TIA) and minor stroke are associated with a substantial risk of subsequent stroke; however, there is uncertainty about whether such patients require admission to hospital for their initial management. We used data from a clinical stroke registry to determine the frequency and predictors of hospitalization for TIA or minor stroke across the province of Ontario, Canada. Methods: The Ontario Stroke Registry collects information on a population-based sample of all patients seen in the emergency department with acute stroke or TIA in Ontario. We identified patients with minor ischemic stroke or TIA included in the registry between April 1, 2008, and March 31, 2011, and used multivariable analyses to evaluate predictors of hospitalization. Results: Our study sample included 8540 patients with minor ischemic stroke or TIA, 47.2% of whom were admitted to hospital, with a range of 37.6% to 70.3% across Ontario’s 14 local health integration network regions. Key predictors of admission were preadmission disability, vascular risk factors, presentation with weakness, speech disturbance or prolonged/persistent symptoms, arrival by ambulance, and presentation on a weekend or during periods of emergency department overcrowding. Conclusions: More than one-half of patients with minor stroke or TIA were not admitted to the hospital, and there were wide regional variations in admission patterns. Additional work is needed to provide guidance to health care workers around when to admit such patients and to determine whether discharged patients are receiving appropriate follow-up care.

Variables prédictives d’hospitalisation chez des patients victimes d’une ischémie cérébrale transitoire ou d’un AVC mineur. Contexte: Une ischémie cérébrale transitoire (ICT) et un AVC mineur sont associés au risque notable d’être victime d’un autre AVC. Il subsiste cependant des doutes quant à la nécessité d’hospitaliser des patients pour un suivi initial. Nous avons donc utilisé les données d’un registre clinique concernant les AVC pour déterminer la fréquence et les variables prédictives d’une hospitalisation à la suite d’une ICT ou d’un AVC mineur partout en Ontario (Canada). Méthodes: Le Registre de l’AVC de l’Ontario recueille des données au sein d’un échantillon représentatif composé de tous les patients examinés dans un service d’urgence ontarien à la suite d’un ICT ou d’un AVC mineur. Nous avons ainsi identifié les patients victimes d’une ICT et d’un AVC mineur inclus dans le registre entre le 1er avril 2008 et le 31 mars 2011. Nous avons ensuite procédé à des analyses multi-variables afin d’évaluer les variables prédictives d’une hospitalisation. Résultats: L’échantillon visé par notre étude incluait 8540 patients victimes d’une ICT ou d’un AVC mineur ; sur ce total, 47,2 % ont été hospitalisés, les pourcentages variant de 37,6 % à 70,3 % dans les 14 Réseaux locaux d’intégration des services de santé (RLISS) de l’Ontario. Les principales variables prédictives d’une hospitalisation se sont révélées être un handicap antérieur à cette hospitalisation, des facteurs de risque vasculaire, des signes de faiblesse, des troubles de la parole ou des symptômes persistants et prolongés de ces troubles, une arrivée en ambulance et une visite à l’hôpital les fins de semaine ou lorsque les services d’urgence sont encombrés. Conclusions: Plus de la moitié des patients victimes d’un AVC mineur ou d’une ICT n’a pas été hospitalisée. Qui plus est, on peut noter de fortes variations régionales en ce qui regarde la tendance à l’hospitalisation. Il est aussi nécessaire de fournir au personnel de la santé des lignes directrices pour savoir s’il est nécessaire ou non d’hospitaliser tels patients et si ceux ayant obtenu leur congé bénéficient d’un suivi adéquat.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Predictors of Hospitalization in Patients With Transient Ischemic Attack or Minor Ischemic Stroke
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Predictors of Hospitalization in Patients With Transient Ischemic Attack or Minor Ischemic Stroke
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Predictors of Hospitalization in Patients With Transient Ischemic Attack or Minor Ischemic Stroke
      Available formats
      ×

Copyright

Corresponding author

Correspondence to: Moira K. Kapral, Toronto General Hospital, 14EN 215 - 200 Elizabeth Street, Toronto, Ontario M5G 2C4 Canada Email: moira.kapral@uhn.ca

References

Hide All
1. Giles, MF, Rothwell, PM. Risk of stroke early after transient ischaemic attack: a systematic review and meta-analysis. Lancet Neurol. 2007;6:1063-1072.
2. Rothwell, PM, Giles, MF, Chandratheva, A, et al. Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison. Lancet. 2007;370:1432-1442.
3. Lavallée, PC, Meseguer, E, Abboud, H, et al. A transient ischaemic attack clinic with round-the-clock access (SOS-TIA): feasibility and effects. Lancet Neurol. 2007;6:953-960.
4. Amarenco, P. Not all patients should be admitted to the hospital for observation after a transient ischemic attack. Stroke. 2012;43:1448-1449.
5. Cucchiara, BL, Kasner, SE. All patients should be admitted to the hospital after a transient ischemic attack. Stroke. 2012;43:1446-1447.
6. Donnan, GA, Davis, SM, Hill, MD, Gladstone, DJ. Patients with transient ischemic attack or minor stroke should be admitted to hospital. Stroke. 2006;37:1137-1138.
7. Lindley, RI. Patients with transient ischemic attack do not need to be admitted to hospital for urgent evaluation and treatment. Stroke. 2006;37:1139-1140.
8. Rothwell, PM, Giles, MF, Flossmann, E, et al. A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack. Lancet. 2005;366:29-36.
9. Johnston, SC, Rothwell, PM, Nguyen-Huynh, MN, et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet. 2007;369:283-292.
10. Kiyohara, T, Kamouchi, M, Kumai, Y, et al. ABCD3 and ABCD3-I scores are superior to ABCD2 score in the prediction of short- and long-term risks of stroke after transient ischemic attack. Stroke. 2014;45:418-425.
11. Merwick, Á, Albers, GW, Amarenco, P, et al. Addition of brain and carotid imaging to the ABCD2 score to identify patients at early risk of stroke after transient ischaemic attack: a multicentre observational study. Lancet Neurol. 2010;9:1060-1069.
12. Coutts, SB, Modi, J, Patel, SK, Demchuk, AM, et al. CT/CT angiography and MRI findings predict recurrent stroke after transient ischemic attack and minor stroke: results of the prospective CATCH study. Stroke. 2012;43:1013-1017.
13. Perry, JJ, Sharma, M, Sivilotti, MLA, et al. Prospective validation of the ABCD2 score for patients in the emergency department with transient ischemic attack. CMAJ. 2011;183:1137-1145.
14. Hill, MD, Coutts, SB. Preventing stroke after transient ischemic attack. CMAJ. 2011;183:1127-1128.
15. Kapral, MK, Silver, FL, Richards, JA, et al. Registry of the Canadian Stroke Network. Progress Report 2001-2005. Toronto: Institute for Clinical Evaluative Sciences; 2005.
16. Asplin, BR. Measuring crowding: time for a paradigm shift. Acad Emerg Med. 2006;13:459-461.
17. Edlow, JA, Kim, S, Pelletier, AJ, Camargo, CA Jr. National study on emergency department visits for transient ischemic attack, 1992-2001. Acad Emerg Med. 2006;13:666-672.
18. Durrani-Tariq, S, Eskin, B, Allegra, JR. Admission rates of ED patients with transient ischemic attack have increased since 2000. Am J Emerg Med. 2013;31:1349-1351.
19. Chaudhry, SA, Tariq, N, Majidi, S, et al. Rates and factors associated with admission in patients presenting to the ED with TIA in the United States - 2006 to 2008. Am J Emerg Med. 2013;31:516-519.
20. Josephson, SA, Sidney, S, Pham, TN, Bernstein, AL, Johnston, SC. Factors associated with the decision to hospitalize patients after transient ischemic attack before publication of prediction rules. Stroke. 2008;39:411-413.
21. Torres MacHo, J, Peña Lillo, G, Pérez Martínez, D, et al. Outcomes of atherothrombotic transient ischemic attack and minor stroke in an emergency department: results of an outpatient management program. Ann Emerg Med. 2011;57:510-516.
22. Olivot, JM, Wolford, C, Castle, J, et al. Two aces: transient ischemic attack work-up as outpatient assessment of clinical evaluation and safety. Stroke. 2011;42:1839-1843.
23. Hörer, S, Haberl, RL, Schulte-Altedorneburg, G. 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.
24. Wasserman, J, Perry, J, Dowlatshahi, D, et al. Stratified, urgent care for transient ischemic attack results in low stroke rates. Stroke. 2010;41:2601-2605.
25. Wu, CM, Manns, BJ, Hill, MD, Ghali, W, et al. Rapid evaluation after high-risk TIA is associated with lower stroke risk. Can J Neurol Sci. 2009;36:450-455.

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed