Objective: The TIA-IS ratio, defined as the proportion of transient ischemic attack (TIA) among all TIA and ischemic stroke (IS) cases, varies between hospitals and between board-certified neurologists. Background The short duration of symptoms and multitude of non-vascular mimics make diagnosis of TIA subjective and challenging. Physician practice may influence whether a patient receives the diagnosis of TIA. Pathophysiology is the same for TIA and IS; therefore, the proportion of TIA versus IS should be the same across demographic and clinical strata and theoretically not vary between physicians. Design/Methods: Cases were identified using primary ICD9 discharge codes at three Montefiore hospitals, including a community hospital without neurology housestaff, from January 2009-June 2011. The TIA-IS ratio was determined for each hospital and for each board-certified neurologist with more than 25 TIA or IS discharges. Each TIA diagnosis was also confirmed by chart review, excluding cases with acute IS on brain imaging, duration >24 hours or a clearly non-vascular syndrome. Mantel-Hantsel chi-square was used for univariate statistical comparison. Results: There were 866 TIA and 2307 IS cases by primary ICD9 code, for an overall TIA-IS ratio of 27.3 %. The ratio was higher for the hospital lacking neurology housestaff (38.8%) versus the two hospitals with housestaff (25.5%, p Conclusions: The TIA-IS ratio differs between hospitals and varies widely among board-certified neurologists, with vascular neurologists less likely to diagnose TIA. The ABCD2 score, assessing symptoms and vascular risk factors, is promoted as a criterion for admission; however, these data suggest that physician training and perspective affect TIA diagnosis and thus assessment of future stroke risk. Disclosure: Dr. Bhupali has nothing to disclose. Dr. Sheikh has nothing to disclose. Dr. Labovitz has nothing to disclose.
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