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Rapid Evaluation after High-Risk TIA is Associated with Lower Stroke Risk

  • Caren M. Wu (a1), Braden J. Manns (a1) (a2), Michael D. Hill (a3), William A. Ghali (a1) (a2), Cam Donaldson (a2) (a4) and Alastair M. Buchan (a3) (a5)...

Abstract

Background:

Current ‘standard of care’ for patients presenting with a ‘high-risk’ TIA varies, with use of several outpatient and inpatient approaches. We describe the clinical outcomes and costs for high risk TIA patients who received care in a ‘rapid evaluation unit’, and compare these to a historical ‘high-risk’ cohort.

Methods:

The study cohort was comprised of patients with TIA admitted to a ‘rapid evaluation unit’ during the period March 2002 to April 2003. The comparison cohort was established by screening Calgary Health Region ER discharge records to identify all patients presenting with a diagnosis of TIA during the year 2000. A ‘high-risk standard care cohort’ was then identified based on the clinical admission criteria used to select patients for the rapid evaluation unit. Outcomes (stroke within 90 days, death) and costs were identified using chart review and provincial administrative data.

Results:

The early risk of stroke in the high risk standard care group (392 patients) was 9.7%, compared to 4.7% in the rapid evaluation cohort (189 patients) (p=0.05). Median 1-year costs post TIA were CAN$8360 for patients in the rapid evaluation cohort, compared with CAN$4820 for patients in the high risk standard care group (p<0.001).

Conclusions:

The risk of early stroke was lower for patients in the rapid evaluation cohort compared to the high risk standard care cohort, suggesting that the use of rapid evaluation programs in patients with TIA at high risk of stroke may be beneficial, but incur greater costs over the course of the first year.

RÉSUMÉ: Résumé : Contexte :

Actuellement, les « normes de soins établies » pour les patients qui consultent pour une ICT à haut risque varient et différentes lignes de conduite chez les patients externes et les patients hospitalisés sont préconisées. Nous décrivons les résultats cliniques et les coûts chez les patients atteints d’ICT à haut risque qui reçoivent des soins dans une « unité dߣévaluation rapide » et nous comparons ces cas à une cohorte historique « à haut risque ».

Méthodes :

La cohorte de sujets était constituée de patients ayant consulté pour une ICT qui ont été évalués dans une « unité d’évaluation rapide » entre mars 2002 et avril 2003. La cohorte témoin a été constituée par révision des dossiers de patients qui ont reçu leur congé de l’unité des urgences de la Calgary Health Region pour identifier tous les patients chez qui un diagnostic d’ICT a été posé au cours de l’année 2000. Selon les critères cliniques d’admission utilisés pour choisir les patients pour l’unité d’évaluation rapide, une cohorte de patients à haut risque qui a reçu des soins standards a été identifiée. L’issue (accident vasculaire cérébral dans les 90 jours, décès) et les coûts ont été déterminés par une revue des dossiers et des données administratives provinciales.

Résultats :

Le risque précoce d’accident vasculaire cérébral dans le groupe à haut risque qui a reçu des soins standards (392 patients) était de 9,7% comparé à 4,7% dans la cohorte qui a bénéficié de l’évaluation rapide (189 patients) (p = 0,05). Un an après l’ICT, les coûts étaient de 8 360 $CA pour les patients de la cohorte d’évaluation rapide et de 4 821 $CA pour les patients du groupe de soins standards de patients à haut risque (p < 0,001).

Conclusions :

Le risque d’un AVC précoce était plus faible chez les patients de la cohorte d’évaluation rapide par rapport à la cohorte de soins standards chez des patients à haut risque, ce qui suggère que l’utilisation de programmes d’évaluation rapide chez les patients présentant une ICT à haut risque d’AVC puisse être bénéfique mais génère des coûts plus élevés au cours de la première année.

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Copyright

Corresponding author

University of Calgary, Health Sciences Centre, 3330 Hospital Drive, Room 1443, Calgary Alberta, T2N 4N1, Canada

References

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