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JAMA Sub-issue: Outpatient or inpatient?

 Last Update: 2022-01-22
 Source: Internet
 Author: User

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risk management process

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Transient ischemic attacks (TIAs) often indicate a high risk of subsequent cerebral ischemic events
.

Studies have shown that stroke risk after TIA can be reduced by 80% if secondary stroke prevention

Transient ischemic attacks (TIAs) often indicate a high risk of subsequent cerebral ischemic events

consensus

To estimate and compare the risk of subsequent ischemic stroke in patients with TIA or minor ischemic stroke (mIS) in different care settings, experts from the University of Pennsylvania Neuroscience Institute conducted a meta-study published in JAMA in Network Open magazine
.

JAMA

We searched all databases including MEDLINE, Web of Science, etc.
, and studies evaluating the occurrence of ischemic stroke after TIA or mIS were included
.

Primary evaluation TIA or TIA receiving care in fast-track TIA or neurology clinics, inpatient departments, emergency departments (ED), and unspecified or multiple settings within 4 evaluation intervals (i.

The analysis included 226,683 patients from 71 articles recruited between 1981 and 2018; 5,636 patients were treated at TIA clinics (mean [SD] age, 65.
7 [3.
9] years; 2,291 of 4,513 [50.
8%]) men), 130,139 were inpatients, 3,605 were in emergency rooms, and 87,303 were cared for in unspecified settings
.

Among patients treated in a TIA clinic, the risk of subsequent stroke within 2 days after TIA or mIS was 0.
3% (95% CI, 0.
0%-1.
2%) and 1.
0% (95% CI, 0.
3%-2.
0%) within 7 days , 1.
3% (95% CI, 0.
4%-2.
6%) within 30 days, and 2.
1% (95% CI, 1.
4%-2.
8%) within 90 days
.

Among hospitalized patients, the risk of stroke was 0.

Among patients treated in a TIA clinic, the risk of subsequent stroke within 2 days after TIA or mIS was 0.

Subsequent ischemic stroke risk within 90 days

Among patients treated at TIA clinics, the risk of stroke was not significantly different from hospitalized patients
.

Compared with the inpatient cohort, TIA clinic patients were younger and had lower ABCD2 scores (inpatients with ABCD2 score >3, 61.

Among patients treated at TIA clinics, the risk of stroke was not significantly different from hospitalized patients

CONCLUSIONS: Patients evaluated at TIA clinics did not have a higher risk of subsequent stroke than hospitalized patients

references:

Risk of Subsequent Stroke Among Patients Receiving Outpatient vs Inpatient Care for Transient Ischemic Attack: A Systematic Review and Meta-analysis.

Risk of Subsequent Stroke Among Patients Receiving Outpatient vs Inpatient Care for Transient Ischemic Attack: A Systematic Review and Meta-analysis.
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