CJEM Infographic: Management of TIA in the Emergency Department

In Infographics, Medical Concepts by Simon Huang1 Comment

1 This month CanadiEM is featuring an article from the Canadian Journal of Emergency Medicine (CJEM) that focuses on the treatment of transient ischemic attack (TIA) in the emergency department (ED). Current recommendations for these patients include brain imaging, noninvasive vascular imaging (carotids), ECG, initiating or modifying preventative medications (e.g. anticoagulants) and referral to a stroke prevention clinic.1However, despite these recommendations, a nation-wide audit of stroke and TIA care in Canada has shown that most patients do not receive timely investigations and treatment.2

To assess the quality of care for TIA patients in the ED and the impact of neurovascular clinic on patient outcomes, Hosier et al. performed a retrospective cohort study of 686 TIA patients in the Capital District Health Authority in Nova Scotia.3 As this CanadiEM infographic shows, patients were grouped based on whether they were seen in the ED and neurovascular clinic or the ED only. These cohorts were then compared for their readmission rates within 90 days for ischemic stroke, myocardial infarction or vascular death. Their results showed that the risk of stroke, MI and vascular death was lower for patients who followed up with the neurovascular clinic (adjusted hazard ratio 0.28; 95% CI 0.08-0.99). Despite this, only 51% of TIA patients were referred to clinic, with 36% showing up for their scheduled appointment.

The results of this study suggest that outpatient neurovascular clinics are underutilized by ED physicians. These clinics help expedite investigations and improve access to professionals with expertise in stroke care, thereby improving patient outcomes.

Download the Infographic as a PDF here.

References

1.
Coutts S, Wein T, Lindsay M, et al. Canadian Stroke Best Practice Recommendations: secondary prevention of stroke guidelines, update 2014. Int J Stroke. 2015;10(3):282-291. [PubMed]
2.
Quality of Stroke Care in Canada (2011). Canadian Stroke Network. http://canadianstrokenetwork.ca/en/service/quality-of-stroke-care-in-canada-2011/. Published 2011. Accessed September 22, 2016.
3.
Hosier G, Phillips S, Doucette S, Magee K, Gubitz G. Transient ischemic attack: management in the emergency department and impact of an outpatient neurovascular clinic. CJEM. 2016;18(5):331-339. [PubMed]
Simon Huang

Simon Huang

Simon Huang is a medical student at the University of Saskatchewan. Prior to starting medical school, he completed his Masters in Biochemistry at McMaster University. He is currently involved in infographic creation for CanadiEM and CJEM.
Simon Huang
- 2 weeks ago
  • vtach

    The study showed that the clinics were so effective that the patients who were referred to the clinic had improved outcomes even before they made it to their first appointment! I wonder what are the magical treatments that reduced the risk of bad outcomes by 70%, giving a NNT of 1.4 over one year?

    was it ASA (NNT of 50)
    was it oral anticoagulants for the subset in atrial fibrillation (NNT of 25)
    was it treatment of hypertension (NNT of 125 over 5 years)
    was it statins (NNT of 125 over 5 years)
    (numbers from http://www.thennt.com)

    …or else was this observational study confounded by referral bias and immortal time bias.