A retrospective analysis of inpatient compared to outpatient care for the management of patients with transient ischaemic attack.

The management of transient ischaemic attacks (TIA) involves rapid evaluation and treatment to reduce the risk of subsequent stroke. In this study we compared the investigation, management and outcome of TIA in those patients who had been admitted to hospital and in those who were evaluated on an outpatient basis. We retrospectively reviewed all patients presenting to the emergency department during a 2.5-year period with a diagnosis of TIA. Follow-up data were obtained by accessing the outpatient records of local neurologists and general practitioners. Patients managed on an outpatient basis were compared to those who were admitted for further evaluation. A total of 140 patients were available for analysis: 40% of presentations were evaluated on an outpatient basis. Admitted patients had higher mean ABCD(2) scores (4.4 versus [vs.] 3.6). They were significantly more likely to receive carotid ultrasonography (95% vs. 73%), 24-hour electrocardiographic monitoring (40% vs. 13%) and lipid evaluations (89% vs. 58%) than those managed as outpatients. The 7-day and 90-day stroke rates were 2% and 6% respectively. No patients with a score of ≤2 suffered subsequent stroke. As expected, patients with higher ABCD(2) scores were more likely to be admitted for further evaluation. Outpatients were investigated less assiduously, but therapeutic management was similar in the two groups. This suggests that inpatient care is superior to outpatient management for high-risk patients but dedicated, specialist outpatient care remains a model worthy of further consideration. Crown