320 Emergency Department Use of Neuroimaging and Hospitalization for Transient Ischemic Attacks in the United States: A Cross-Sectional Study

Abstract

OBJECTIVES/GOALS: A TIA is a transient episode of symptoms attributed to a cerebrovascular cause, and associated with an increased risk of stroke. Care of these patients often requires substantial resources in the Emergency Department (ED). We therefore described neuroimaging and hospitalization use for TIA within a nationally representative sample of US ED visits. METHODS/STUDY POPULATION: Retrospective cross-sectional analysis using TIA encounters in the 2018 National Emergency Department Sample (NEDS), an AHRQ dataset consisting of a weighted sample of 20% of all US ED encounters. Non-contrast Head CT, CTA Head, Carotid Ultrasound, MRI and CT Perfusion imaging utilization was determined based on Common Procedural Terminology (CPT) codes in the non-admitted encounters. The study population includes all adult patients with a discharge diagnosis of TIA as determined by ICD-10 codes (H34.0, G45.0-3, G45.8 G45.9) in any diagnosis position. The percentage of patients receiving each neuroimaging test was reported with the corresponding 95% confidence interval (CI). We utilized survey sample weights to generate reliable national estimates. RESULTS/ANTICIPATED RESULTS: The study population consisted of 80,803 ED encounters with a discharge diagnosis of TIA, representing 326,802 weighted ED visits nationally. Among this group, 46.8% of patients were discharged and 41.8% were admitted to the same hospital, 7% of patients were transferred to another facility, and the remaining 5% left AMA, were dispositioned to home health, died in the ED, or had an unknown disposition. Because discharged encounters retain their more precise CPT coding of procedural information, imaging analysis was conducted in discharged TIA encounters only. Of these encounters, 73% (95% CI, 70.7-76.5) received a noncontrast head CT, 20.9% (95% CI, 19.1-22.7) a CTA Head, 22.5% (95% CI, 20.6-24.4) a carotid ultrasound, and 31.5% (95% CI, 29.3-33.7) an MRI brain without contrast. DISCUSSION/SIGNIFICANCE: The discharge rate of just under 50% of patients is consistent with other published data, and represents a gradual trend over the past decade of decreased admissions for TIA. The fact that for many of these patients, the entire episode of care occurs in the ED setting suggests that the ED may be a rich target for future innovations in care for TIA.