Short-term Prognosis After Emergency Department Diagnosis of TIA

CONTEXT Management of patients with acute transient ischemic attack (TIA) varies widely, with some institutions admitting all patients and others proceeding with outpatient evaluations. Defining the short-term prognosis and risk factors for stroke after TIA may provide guidance in determining which...

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Bibliographic Details
Published in:JAMA : the journal of the American Medical Association 2000-12, Vol.284 (22), p.2901-2906
Main Authors: Johnston, S. Claiborne, Gress, Daryl R, Browner, Warren S, Sidney, Stephen
Format: Article
Language:English
Subjects:
Aged
Analysis. Health state
Biological and medical sciences
Cohort Studies
Emergency Service, Hospital
Epidemiology
Female
General aspects
Health risk assessment
Hospitalization
Humans
Ischemic Attack, Transient - complications
Ischemic Attack, Transient - diagnosis
Ischemic Attack, Transient - mortality
Ischemic Attack, Transient - therapy
Logistic Models
Male
Medical diagnosis
Medical sciences
Middle Aged
Neurology
Prognosis
Public health. Hygiene
Public health. Hygiene-occupational medicine
Risk Factors
Stroke
Stroke - etiology
Vascular diseases and vascular malformations of the nervous system
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Summary:CONTEXT Management of patients with acute transient ischemic attack (TIA) varies widely, with some institutions admitting all patients and others proceeding with outpatient evaluations. Defining the short-term prognosis and risk factors for stroke after TIA may provide guidance in determining which patients need rapid evaluation. OBJECTIVE To determine the short-term risk of stroke and other adverse events after emergency department (ED) diagnosis of TIA. DESIGN AND SETTING Cohort study conducted from March 1997 through February 1998 in 16 hospitals in a health maintenance organization in northern California. PATIENTS A total of 1707 patients (mean age, 72 years) identified by ED physicians as having presented with TIA. MAIN OUTCOME MEASURES Risk of stroke during the 90 days after index TIA; other events, including death, recurrent TIA, and hospitalization for cardiovascular events. RESULTS During the 90 days after index TIA, 180 patients (10.5%) returned to the ED with a stroke, 91 of which occurred in the first 2 days. Five factors were independently associated with stroke: age greater than 60 years (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1-2.7; P = .01), diabetes mellitus (OR, 2.0; 95% CI, 1.4-2.9; P
ISSN:0098-7484
1538-3598
DOI:10.1001/jama.284.22.2901