Abstract

Background: The risk of recurrent brain infarction (BI) is high within the first hours after a transient ischemic attack (TIA). Emergent, specialized, and tailored patient management in a TIA program reduces the risk of recurrent BI after TIA by 80%. New antithrombotic strategies have been successfully tested within 12 h after TIA onset. We aim to investigate the factors associated with a delay of more than 12 h from TIA onset to evaluation in our TIA clinic.Methods: In consecutive patients evaluated in our TIA clinic from 01/2012 to 11/2013, we prospectively collected delays from onset to arrival, baseline characteristics, discharge diagnosis and recurrent BI at 1 week. Referring pathways were dichotomized between office-based physicians (OBP) and emergency departments (ED). Univariate and multivariate logistic regression were performed.Results: 354 patients were evaluated. Mean (+/– SD) age was 61 years (+/−18). Median (IQR) ABCD2 score was 3 (2–4). Median (IQR) delay from onset to evaluation was 8 h (4–48). Overall, 185 (52%) were referred by OBP vs. 169 (48%) by ED. Evaluation was initiated within 12 h among 201 (57%) patients. After logistic regression, OBP referral was by comparison with ED the only independent factor associated with an evaluation delay >12 h (OR 5.7, 95% CI: 3.5–9.3, p < 0.0001).Conclusion: Our results suggest that preliminary assessment by OBP may increase the delay to initiate the emergent evaluation of TIA patients. Promoting direct admission to TIA clinics through ED may be an efficient alternative for high risk TIAs.

Highlights

  • Up to one third of cases of acute brain infarction (BI) have been preceded by a transient ischemic attack (TIA) [1]

  • We investigated the factors associated with the delay between the symptom onset and the initiation of the evaluation in our TIA clinic using 12 h as a cut off for evaluation

  • Clinical information on consecutive patients referred to our TIA clinic between January, 2012 and November, 2013, were prospectively collected and reviewed

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Summary

Introduction

Up to one third of cases of acute brain infarction (BI) have been preceded by a transient ischemic attack (TIA) [1]. The emergent, specialized, and tailored management of TIA in the setting of a specific TIA pathway (TIA clinic, clinical decision unit; etc.) reduces the risk of recurrent stroke by 80% [5, 6]. The Platelet-Oriented Inhibition in New TIA (POINT) study demonstrated that the combination of aspirin with clopidogrel therapy initiated within 12 h after TIA onset reduces the risk of recurrent BI by comparison with aspirin alone [7]. Delays in TIA patient evaluation may have a major impact on the risk of recurrent stroke after a TIA. The risk of recurrent brain infarction (BI) is high within the first hours after a transient ischemic attack (TIA). Emergent, specialized, and tailored patient management in a TIA program reduces the risk of recurrent BI after TIA by 80%. We aim to investigate the factors associated with a delay of more than 12 h from TIA onset to evaluation in our TIA clinic

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