Top

Published in:

01-04-2009 | original article

Evaluation of Transient Ischemic Attack in an Emergency Department Observation Unit

Authors: Latha G. Stead, M. Fernanda Bellolio, Smitha Suravaram, Robert D. Brown Jr., Anjali Bhagra, Rachel M. Gilmore, Eric T. Boie, Wyatt W. Decker

Published in: Neurocritical Care | Issue 2/2009

Abstract

Objective

To evaluate the feasibility of a protocol for evaluation of transient ischemic attack (TIA) in an Emergency Department Observation Unit (EDOU), and assess the risk of early stroke after such an evaluation.

Methods

All adult patients presenting to the Emergency Department (ED) with signs and symptoms consistent with TIA were prospectively enrolled in this observational study over a period of 3 years. Patients underwent a standardized TIA evaluation per protocol. Risk of subsequent stroke at 48 h, 1 week, 1 month, and 3 months was prospectively assessed.

Results

In total, 418 patients were seen during the study period, and all were evaluated per the EDOU TIA protocol. The mean age was 73.1 (±13.3) years and 53.8% were males. Comorbidities included hypertension in 71.5%, diabetes mellitus in 20.1%, prior TIA in 19.6%, and prior ischemic stroke in 19.6% of the cohort. Brain CT, neurology consult, electrocardiogram, carotid ultrasound, and additional tests were performed, and education was given. A total of 30.4% of the patients were dismissed directly from the EDOU. The risk of stroke at 2 days was 0.96%, at 7 days 1.2%, at 30 days 1.9%, and 2.4% at 90 days.

Conclusion

An Emergency Department Observation Unit Protocol for TIA is a feasible option for expedited evaluation of these patients.

Edlow JA, Kim S, Pelletier AJ, Camargo CA Jr. National study on emergency department visits for transient ischemic attack, 1992–2001. Acad Emerg Med. 2006;13(6):666–72.PubMed

Johnston SC. Clinical practice. Transient ischemic attack. N Engl J Med. 2002;347(21):1687–92. doi:10.1056/NEJMcp020891.PubMedCrossRef

Rosamond W, Flegal K, Furie K, et al. Heart disease and stroke statistics—2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2008;117(4):e25–146. doi:10.1161/CIRCULATIONAHA.107.187998.PubMedCrossRef

Johnston SC, Gress DR, Browner WS, Sidney S. Short-term prognosis after emergency department diagnosis of TIA. JAMA. 2000;284(22):2901–6. doi:10.1001/jama.284.22.2901.PubMedCrossRef

Brown RD Jr, Petty GW, O’Fallon WM, Wiebers DO, Whisnant JP. Incidence of transient ischemic attack in Rochester, Minnesota, 1985–1989. Stroke. 1998;29(10):2109–13.PubMed

Giles MF, Rothwell PM. Risk of stroke early after transient ischaemic attack: a systematic review and meta-analysis. Lancet Neurol. 2007;6(12):1063–72.PubMedCrossRef

Flemming KD, Brown RD Jr, Petty GW, Huston J 3rd, Kallmes DF, Piepgras DG. Evaluation and management of transient ischemic attack and minor cerebral infarction. Mayo Clin Proc. 2004;79(8):1071–86.PubMedCrossRef

Crenshaw LA, Lindsell CJ, Storrow AB, Lyons MS. An evaluation of emergency physician selection of observation unit patients. Am J Emerg Med. 2006;24(3):271–9. doi:10.1016/j.ajem.2005.11.002.PubMedCrossRef

Scribano PV, Wiley JF 2nd, Platt K. Use of an observation unit by a pediatric emergency department for common pediatric illnesses. Pediatr Emerg Care. 2001;17(5):321–3. doi:10.1097/00006565-200110000-00001.PubMedCrossRef

10.

Graff L, Radford MJ, Werne C. Probability of appendicitis before and after observation. Ann Emerg Med. 1991;20(5):503–7. doi:10.1016/S0196-0644(05)81603-8.PubMedCrossRef

11.

The World Health Organization MONICA Project (monitoring trends and determinants in cardiovascular disease): a major international collaboration. WHO MONICA Project Principal Investigators. J Clin Epidemiol. 1988;41(2):105–14. doi:10.1016/0895-4356(88)90084-4.

12.

Adams HP Jr, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24(1):35–41.PubMed

13.

Hockberger RS, Binder LS, Graber MA, et al. The model of the clinical practice of emergency medicine. Ann Emerg Med. 2001;37(6):745–70. doi:10.1067/mem.2001.115495.PubMedCrossRef

14.

Mace SE, Shah J. Observation medicine in emergency medicine residency programs. Acad Emerg Med. 2002;9(2):169–71.PubMedCrossRef

15.

Hoekstra JW, Gibler WB, Levy RC, et al. Emergency-department diagnosis of acute myocardial infarction and ischemia: a cost analysis of two diagnostic protocols. Acad Emerg Med. 1994;1(2):103–10.PubMed

16.

de Leon AC Jr, Farmer CA, King G, Manternach J, Ritter D. Chest pain evaluation unit: a cost-effective approach for ruling out acute myocardial infarction. South Med J. 1989;82(9):1083–9.PubMed

17.

Rydman RJ, Isola ML, Roberts RR, et al. Emergency Department Observation Unit versus hospital inpatient care for a chronic asthmatic population: a randomized trial of health status outcome and cost. Med Care. 1998;36(4):599–609.PubMedCrossRef

18.

Zwicke DL, Donohue JF, Wagner EH. Use of the emergency department observation unit in the treatment of acute asthma. Ann Emerg Med. 1982;11(2):77–83. doi:10.1016/S0196-0644(82)80301-6.PubMedCrossRef

19.

Peacock WF 4th, Remer EE, Aponte J, Moffa DA, Emerman CE, Albert NM. Effective observation unit treatment of decompensated heart failure. Congest Heart Fail. 2002;8(2):68–73. doi:10.1111/j.1527-5299.2002.01519.x.PubMedCrossRef

20.

Wakai A, O’Neill JO. Emergency management of atrial fibrillation. Postgrad Med J. 2003;79(932):313–9. doi:10.1136/pmj.79.932.313.PubMedCrossRef

21.

Shen WK, Decker WW, Smars PA, et al. Syncope Evaluation in the Emergency Department Study (SEEDS): a multidisciplinary approach to syncope management. Circulation. 2004;110(24):3636–45. doi:10.1161/01.CIR.0000149236.92822.07.PubMedCrossRef

22.

Sztajnkrycer MD, Mell HK, Melin GJ. Development and implementation of an emergency department observation unit protocol for deliberate drug ingestion in adults—preliminary results. Clin Toxicol (Phila). 2007;45(5):499–504. doi:10.1080/15563650701354168.

23.

Lemke T, Wang R. Emergency department observation for toxicologic exposures. Emerg Med Clin North Am. 2001;19(1):155–67, viii. doi:10.1016/S0733-8627(05)70173-5.

24.

Kelen GD, Scheulen JJ, Hill PM. Effect of an emergency department (ED) managed acute care unit on ED overcrowding and emergency medical services diversion. Acad Emerg Med. 2001;8(11):1095–100. doi:10.1111/j.1553-2712.2001.tb01122.x.PubMedCrossRef

25.

Lewin_Group. Emergency Department Overload: a growing crisis. In: Association AH, editor. The results of the AHA Survey of Emergency Department and Hospital Capacity, 2002. http://www.aha.org/aha/content/2002/pdf/EdoCrisisSlides.pdf.

Title: Evaluation of Transient Ischemic Attack in an Emergency Department Observation Unit
Authors: Latha G. Stead
M. Fernanda Bellolio
Smitha Suravaram
Robert D. Brown Jr.
Anjali Bhagra
Rachel M. Gilmore
Eric T. Boie
Wyatt W. Decker
Publication date: 01-04-2009
Publisher: Humana Press Inc
Published in: Neurocritical Care / Issue 2/2009
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI: https://doi.org/10.1007/s12028-008-9146-z

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Evaluation of Transient Ischemic Attack in an Emergency Department Observation Unit

Abstract

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2009

Vasopressors and Propofol Infusion Syndrome in Severe Head Trauma

Spanning the Globe

Malplacement of Ventricular Catheters by Neurosurgeons: A Single Institution Experience

The Hydration Influence on the Risk of Stroke (THIRST) Study

Relationship Between Hemoglobin Concentrations and Outcomes Across Subgroups of Patients with Aneurysmal Subarachnoid Hemorrhage

Feasibility of a Continuous Computerized Monitoring of Cerebral Autoregulation in Neurointensive Care