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Adherence to Practice Guidelines for Transient Ischemic Attacks in an Emergency Department

Published online by Cambridge University Press:  02 December 2014

Eddie Chang
Affiliation:
Division of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada Capital Health Authority, Edmonton, Alberta, Canada
Brian R. Holroyd
Affiliation:
Division of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada Capital Health Authority, Edmonton, Alberta, Canada
Peggy Kochanski
Affiliation:
Division of Neurology, University of Alberta, Edmonton, Alberta, Canada
Karen D. Kelly
Affiliation:
Department of Rural Health, The University of Northern Bristish Columbia, Prince George, BC Canada
Ashfaq Shuaib
Affiliation:
Capital Health Authority, Edmonton, Alberta, Canada
Brian H. Rowe
Affiliation:
Division of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada Capital Health Authority, Edmonton, Alberta, Canada
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Abstract:

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Objective:

To evaluate the investigation and treatment of patients with a diagnosis of transient ischemic attacks (TIA) in the emergency department (ED) a tertiary care teaching hospital with a neuroscience referral program.

Methods:

A chart review was conducted in the hospital. Consecutive ED charts with a diagnosis of TIA were included; each was reviewed by independent coders using a standardized data form.

Results:

Two hundred and ninety-three TIAcharts were reviewed; the gender ratio was 1:1 with a mean age of 66 years. Most patients (75%; 95% CI: 70, 80) were evaluated by ED physicians; the remaining patients were seen directly by referral services. The median time from symptom onset to ED arrival was 2.9 hours and the duration of symptoms was 4.6 hours. Most patients received CT scans (81%; 95% CI: 73, 85), complete blood counts (74%; 95% CI: 68, 79), and electrocardiograms (75%; 95% CI: 70, 80) in the ED. In 16% (95% CI: 13, 22) a carotid doppler was performed and in 26% (95% CI: 21, 31) an outpatient doppler was booked. Among those who were discharged (75%; 95% CI: 70, 80), antithrombotic medications were not prescribed to 28% (95% CI: 22, 34).

Conclusion:

Practice variation exists with respect to the investigation and treatment of TIAs in this tertiary-care teaching hospital. Carotid doppler investigation and use of anti-platelet therapy for patients with TIAare suboptimal. Clinical practice guidelines and rapid assessment TIAclinics may change these results.

Résumé:

RÉSUMÉ:Objectif:

Évaluer l’investigation et le traitement à l’urgence des patients ayant un diagnostic d’accès ischémique cérébral transitoire (ICT).

Méthodes:

Une révision des dossiers d’un hôpital de soins tertiaires ayant un programme de référence en neurosciences a été effectuée. Chaque dossier de l’urgence comportant un diagnostic d’ICTa été révisé par des examinateurs indépendants qui attribuaient un code selon un formulaire standardisé.

Résultats:

Deux cent quatrevingt-treize dossiers de patients ayant reçu un diagnostic d’ICT ont été révisés; la proportion d’homme et de femmes était de 1:1 et l’âge moyen était de 66 ans. La plupart des patients (75%; IC 95%: 70 à 80) ont été évalués par des urgentologues; les autres patients ont été vus directement par les services de référence. L’intervalle médian du début des symptômes jusqu’à l’arrivée à l’urgence était de 2,9 heures et la durée des symptômes était de 4,6 heures. La plupart des patients ont subi une tomodensitométrie cérébrale (81%; IC 95%: 73 à 83), une formule sanguine complète (74%; IC 95%: 68 à 79), et un électrocardiogramme (75%; IC 95%: 70 à 80) à l’urgence. Chez 16% (IC 95%: 13 à 22), un Doppler carotidien a été fait et chez 26% (IC 95%: 21 à 31) un Doppler a été demandé en externe. Parmi ceux qui ont reçu leur congé de l’urgence (75%; IC 95%: 70 à 80), aucune medication antithrombotique n’a été prescrite chez 28% (IC 95%: 22 à 34).

Conclusion:

Il existe des variations quant à l’investigation et au traitement de l’ICT dans cet hôpital universitaire de soins tertiaire. L’investigation par Doppler carotidien et l’utilisation d’agents antiplaquettaires chez les patients présentant une ICT est sous-optimale. Des lignes directrices et des cliniques d’évaluation rapide de l’ICTpourraient modifier ces résultats.

Type
Research Article
Copyright
Copyright © The Canadian Journal of Neurological 2002

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