BOSTON — The risk of an early ischemic stroke following a transient ischemic attack is significantly higher in patients who are discharged from the emergency department than in those who are admitted to the hospital for a TIA evaluation.
Neurologist consultation may be a key factor in the protective effect of hospitalization, Dr. Sharon Poisson said at the annual meeting of the American Academy of Neurology. “In the emergency room, only 1% of the discharged group and 4% of the admitted group received a neurologist consultation. But an additional 50% of those who were admitted did see a neurologist during that admission.”
Dr. Poisson of the University of Michigan, Ann Arbor, presented a subanalysis of the Brain Attack Surveillance in Corpus Christi (BASIC) study. The prospective, population-based study tracks strokes and transient ischemic attacks occurring in the coastal Texas city. Dr. Poisson's data were collected from 2000 to 2005 and included 552 first-time probable or possible TIAs. Of these, 31% (171) were discharged from the emergency department and 69% (381) were admitted to the hospital. The average patient age was 71 years; 42% were male.
Stroke occurrence at 3 and 7 days in those discharged from the ED was 4.7% and 5.9%, compared with 0.26% and 0.53% in those admitted. By 30 days, 19 ischemic strokes had occurred in 7% of those discharged and 2% of those admitted–a statistically significant difference.
Over the next 2 years, more ischemic strokes occurred at every time point in those discharged, compared with those admitted, but the differences were not significant.
The association between admission and lower stroke risk persisted even after adjustment for age, gender, ethnicity, hypertension, diabetes, atrial fibrillation, hyperlipidemia, smoking, and coronary artery disease, Dr. Poisson said.