Jun. 2, 2010
TIA Stroke Prevention Measures in ED Observation Unit Found Comparable to Inpatient Unit
The use of a transient ischemic attack (TIA) accelerated diagnostic protocol (ADP) at a university hospital was found to be associated with stroke prevention compliance rates that are comparable to inpatient rates, according to a recent Emory University study.
Study findings by Michael Ross, MD, associate professor of emergency medicine, Emory University School of Medicine, and medical director of observation medicine, Emory Department of Emergency Medicine, were reported this week at the Society for Academic Medicine's annual meeting in Phoenix.
The study sought to determine if compliance rates with stroke prevention measures for TIA patients managed using an accelerated diagnostic protocol (ADP) in an emergency department observation unit (EDOU) are comparable to admitted inpatients at a primary stroke center university hospital.
Ross and his colleagues recently established an emergency department TIA diagnostic protocol, which has shown potential for saving money and time, as well as for dramatically reducing the number of unnecessary hospital admissions for patients diagnosed with TIAs.
Following a diagnosis of TIA, patients were assessed with four different diagnostic tools: serial neurological checks, cardiac monitoring, MRI carotid imaging and echocardiography. Upon completion of the protocol, study patients were discharged if they had no recurrent deficits, negative testing and were clinically stable for discharge home with adequate home support and medications.
"This was a ‘before-after' cohort study of emergency department TIA patients that were either admitted to the neurology service or managed by the ADP over 18 consecutive months. During the 11 months historical control period (pre-ADP) all patients were admitted to the neurology service," explains Ross.
"Over the next seven months, patients were either enrolled in the ADP or admitted to the hospital based on ADP exclusion criteria or physician discretion," says Ross. "We studied compliance with national guidelines for stroke prevention in TIA patients. We found an overall reduction in the median length of hospital stay by 20.8 hours, with an associated increased usage rate of carotid imaging, echocardiography, and appropriate medical therapies."
American Stroke Association (ASA) and National Stroke Association (NSA) stroke prevention measures included compliance with antithrombotic therapy, screening for hyperglycemia, lipid assessment and therapy, vascular imaging and echocardiography (ECHO).
A transient ischemic attack, often referred to as a "mini-stroke" or "warning stroke," is a change in the blood supply to a particular area of the brain, resulting in brief neurologic dysfunction that persists, by definition, for less than 24 hours. If symptoms persist longer, then it is categorized as a stroke.
More than 300,000 Americans are diagnosed with TIAs each year, and more than 10 percent will suffer a full stroke within 90 days, with almost two-thirds of those strokes disabling. Traditionally, TIA patients are admitted for a series of diagnostic tests that take several days. Each year more than 700,000 Americans suffer from stroke, and approximately 85 percent of stroke survivors experience partial paralysis on one side of the body. The annual health care cost for stroke care is approximately $40 billion.
The Robert W. Woodruff Health Sciences Center of Emory University is an academic health science and service center focused on missions of teaching, research, health care and public service.