Initiation of the ABCD3-I algorithm for expediated evaluation of transient ischemic attack patients in an emergency department

• Published in: The American journal of emergency medicine 2020-04, Vol.38 (4), p.741-745
• Main Authors: Dahlquist, Robert T., Young, Joseph M., Reyner, Karina, Farzad, Ali, Moleno, Richard B., Gandham, Gautami, Ho, Amy F., Wang, Hao
• Format: Article
• Language: English
• Subjects: ABCD3-I; Algorithms; Clinical outcomes; Cost control; Emergency department; Emergency medical care; Health care; Ischemia; Magnetic resonance imaging; Medical imaging; Patient admissions; Short term; Stroke; Transient ischemic attack
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2019.06.018

The use of ABCD3-I score for Transient ischemic attack (TIA) evaluation has not been widely investigated in the ED. We aim to determine the performance and cost-effectiveness of an ABCD3-I based pathway for expedited evaluation of TIA patients in the ED. We conducted a single-center, pre- and post-intervention study among ED patients with possible TIA. Accrual occurred for seven months before (Oct. 2016–April 2017) and after (Oct. 2017–April 2018) implementing the ABCD3-I algorithm with a five-month wash-in period (May–Sept. 2017). Total ED length of stay (LOS), admissions to the hospital, healthcare cost, and 90-day ED returns with subsequent stroke were analyzed and compared. Pre-implementation and post-implementation cohorts included 143 and 118 patients respectively. A total of 132 (92%) patients were admitted to the hospital in the pre-implementation cohort in comparison to 28 (24%) patients admitted in the post-implementation cohort (p  0.05). The mean ABCD2 scores were 4.5 (1.4) in pre- and 4.1 (1.3) in post-implementation cohorts (p = 0.01). The mean ABCD3-I scores were 4.5 (1.8) in post-implementation cohorts. Total ED LOS was 310 min (201, 420) in pre- and 275 min (222, 342) in post-implementation cohorts (p > 0.05). Utilization of the ABCD3-I algorithm saved an average of over 40% of total healthcare cost per patient in the post-implementation cohort. The initiation of an ABCD3-I based pathway for TIA evaluation in the ED significantly decreased hospital admissions and cost with similar 90-day neurological outcomes.