Abstract
BackgroundTo evaluate the performance of a novel triage system for Transient Ischemic Attack (TIA) units built upon an existent clinical prediction rule (CPR) to reduce time to unit arrival, relative to the time of symptom onset, for true TIA and minor stroke patients. Differentiating between true and false TIA/minor stroke cases (mimics) is necessary for effective triage as medical intervention for true TIA/minor stroke is time-sensitive and TIA unit spots are a finite resource.MethodsProspective cohort study design utilizing patient referral data and TIA unit arrival times from a regional fast-track TIA unit on Vancouver Island, Canada, accepting referrals from emergency departments (ED) and general practice (GP). Historical referral cohort (N = 2942) from May 2013–Oct 2014 was triaged using the ABCD2 score; prospective referral cohort (N = 2929) from Nov 2014–Apr 2016 was triaged using the novel system. A retrospective survival curve analysis, censored at 28 days to unit arrival, was used to compare days to unit arrival from event date between cohort patients matched by low (0–3), moderate (4–5) and high (6–7) ABCD2 scores.ResultsSurvival curve analysis indicated that using the novel triage system, prospectively referred TIA/minor stroke patients with low and moderate ABCD2 scores arrived at the unit 2 and 1 day earlier than matched historical patients, respectively.ConclusionsThe novel triage process is associated with a reduction in time to unit arrival from symptom onset for referred true TIA/minor stroke patients with low and moderate ABCD2 scores.
Highlights
To evaluate the performance of a novel triage system for Transient Ischemic Attack (TIA) units built upon an existent clinical prediction rule (CPR) to reduce time to unit arrival, relative to the time of symptom onset, for true TIA and minor stroke patients
To remedy the previously discussed triage challenges in our own TIA unit (Stroke Rapid Assessment Unit (SRAU), Victoria, BC, Canada) we developed a novel triage system that combines our previously developed clinical classifier with the ABCD2 score to produce a new weighted triage score
For the low (0–3) ABCD2 risk group, TIA/minor stroke patients arrived two days earlier after implementation of the new triage process compared to the preceding time period; for mimic patients the difference in unit arrival times was not significant
Summary
To evaluate the performance of a novel triage system for Transient Ischemic Attack (TIA) units built upon an existent clinical prediction rule (CPR) to reduce time to unit arrival, relative to the time of symptom onset, for true TIA and minor stroke patients. The focus of triage is to organize and coordinate the risk profiles of multiple patients relative to one another This coordination is dynamically changing in real-time as new referrals arrive at TIA units and current. The definition of high risk TIA/minor stroke patients as being those who present with motor or speech focal neurological deficits is consistent across clinical guidelines. This definition is either explicitly stated [3] or implicitly suggested by reference to the ABCD2 score [6]. The higher the ABCD2 score, the greater the patient’s risk of a subsequent ischemic event
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