Shadi Yaghi1, Joshua Z Willey1, Pooja Khatri1. 1. Department of Neurology, Division of Stroke and Cerebrovascular Diseases (SY), The Alpert Medical School of Brown University, Providence, RI; Department of Neurology, Division of Stroke and Cerebrovascular Diseases (JZW), Columbia University Medical Center, New York, NY; and Department of Neurology, Division of Stroke and Cerebrovascular Diseases (PK), University of Cincinnati, OH.
Abstract
BACKGROUND: Two-thirds of patients with stroke have mild deficits. The optimal triaging of these patients remains unclear. It is crucial to stratify patients based on who needs inpatient vs outpatient evaluation in a cost-effective manner. METHODS: We reviewed the current literature (randomized trials, retrospective studies, case series, and case reports) on minor ischemic stroke and extrapolated evidence-based opinions and future directions on the management of minor ischemic stroke. RESULTS: We provide evidence-based opinions and future directions on the approach to triaging patients with mild deficits based on the early risk of stroke recurrence, feasibility of outpatient diagnostic evaluation, and disabling deficits needing inpatient evaluation by physical and occupational therapy. CONCLUSIONS: Outpatient evaluation of patients with nondisabling minor stroke is potentially cost-effective after excluding large artery atherosclerosis and ensuring a rapid access outpatient evaluation. Larger studies on the cost-effectiveness and safety of this approach are necessary.
BACKGROUND: Two-thirds of patients with stroke have mild deficits. The optimal triaging of these patients remains unclear. It is crucial to stratify patients based on who needs inpatient vs outpatient evaluation in a cost-effective manner. METHODS: We reviewed the current literature (randomized trials, retrospective studies, case series, and case reports) on minor ischemic stroke and extrapolated evidence-based opinions and future directions on the management of minor ischemic stroke. RESULTS: We provide evidence-based opinions and future directions on the approach to triaging patients with mild deficits based on the early risk of stroke recurrence, feasibility of outpatient diagnostic evaluation, and disabling deficits needing inpatient evaluation by physical and occupational therapy. CONCLUSIONS:Outpatient evaluation of patients with nondisabling minor stroke is potentially cost-effective after excluding large artery atherosclerosis and ensuring a rapid access outpatient evaluation. Larger studies on the cost-effectiveness and safety of this approach are necessary.
Authors: F Purroy; P E Jiménez-Caballero; G Mauri-Capdevila; M J Torres; A Gorospe; J M Ramírez Moreno; N P de la Ossa; D Cánovas; J Arenillas; J Alvarez-Sabín; P Martínez Sánchez; B Fuentes; R Delgado-Mederos; J Martí-Fàbregas; A Rodríguez Campello; J Masjuán Journal: Eur J Neurol Date: 2013-03-26 Impact factor: 6.089
Authors: Eric E Smith; Abdul R Abdullah; Iva Petkovska; Eric Rosenthal; Walter J Koroshetz; Lee H Schwamm Journal: Stroke Date: 2005-10-06 Impact factor: 7.914
Authors: Urs Fischer; Adrian Baumgartner; Marcel Arnold; Krassen Nedeltchev; Jan Gralla; Gian Marco De Marchis; Liliane Kappeler; Marie-Luise Mono; Caspar Brekenfeld; Gerhard Schroth; Heinrich P Mattle Journal: Stroke Date: 2010-02-25 Impact factor: 7.914
Authors: Steven R Levine; Pooja Khatri; Joseph P Broderick; James C Grotta; Scott E Kasner; Doojin Kim; Brett C Meyer; Peter Panagos; Jose Romano; Phillip Scott Journal: Stroke Date: 2013-07-11 Impact factor: 7.914
Authors: Shashank Agarwal; Erica Scher; Aaron Lord; Jennifer Frontera; Koto Ishida; Jose Torres; Sara Rostanski; Eva Mistry; Brian Mac Grory; Shawna Cutting; Tina Burton; Brian Silver; Ava L Liberman; Mackenzie P Lerario; Karen Furie; James Grotta; Pooja Khatri; Jeffrey Saver; Shadi Yaghi Journal: Stroke Date: 2020-02-27 Impact factor: 7.914
Authors: Hoda Gad; Adnan Khan; Naveed Akhtar; Saadat Kamran; Ahmed El-Sotouhy; Soha R Dargham; Ioannis N Petropoulos; Georgios Ponirakis; Ashfaq Shuaib; Leopold J Streletz; Rayaz A Malik Journal: PLoS One Date: 2019-03-15 Impact factor: 3.240
Authors: Adam de Havenon; S Claiborne Johnston; J Donald Easton; Anthony S Kim; Kevin N Sheth; Maarten Lansberg; David Tirschwell; Eva Mistry; Shadi Yaghi Journal: JAMA Netw Open Date: 2021-06-01
Authors: Mirjam R Heldner; Caroline Chalfine; Marion Houot; Roza M Umarova; Jan Rosner; Julian Lippert; Laura Gallucci; Anne Leger; Flore Baronnet; Yves Samson; Charlotte Rosso Journal: Front Neurol Date: 2022-02-17 Impact factor: 4.003
Authors: Aleksandra Yakhkind; Ryan A McTaggart; Mahesh V Jayaraman; Matthew S Siket; Brian Silver; Shadi Yaghi Journal: Front Neurol Date: 2016-06-10 Impact factor: 4.003