Seemant Chaturvedi1, Susan Ofner2, Fitsum Baye2, Laura J Myers2, Mike Phipps2, Jason J Sico2, Teresa Damush2, Edward Miech2, Mat Reeves2, Jason Johanning2, Linda S Williams2, Greg Arling2, Eric Cheng2, Zhangsheng Yu2, Dawn Bravata2. 1. From the Miami VA Hospital (S.C.); Department of Neurology (S.C.), University of Miami Miller School of Medicine, FL; Departments of Biostatistics (S.O., F.B.), Internal Medicine (L.J.M., T.D., D.B.), Emergency Medicine (E.M.), and Neurology (L.S.W., D.B.), Indiana University School of Medicine, IUPUI; Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Stroke Quality Enhancement Research Initiative (QUERI) (L.J.M., T.D., E.M., M.R., L.S.W., G.A., D.B.); VA HSR&D Center for Health Information and Communication (CHIC) (L.J.M., T.D., E.M., L.S.W., D.B.), Richard L. Roudebush VA Medical Center, Indianapolis, IN; Department of Neurology (M.P.), University of Maryland School of Medicine, Baltimore; Clinical Epidemiology Research Center (J.J.S.), VA Connecticut Healthcare System, West Haven; Departments of Internal Medicine and Neurology (J.J.S.), Yale University School of Medicine, New Haven, CT; Regenstrief Institute (T.D., E.M., L.S.W., D.B.), Indianapolis, IN; Department of Epidemiology (M.R.), Michigan State University, East Lansing; VA Nebraska-Western Iowa Health Care System-Omaha Division (J.J.), Omaha; Department of Surgery (J.J.), University of Nebraska, Lincoln; Purdue University School of Nursing (G.A.), West Lafayette, IN; Department of Neurology (E.C.), University of California, Los Angeles School of Medicine; and SJTU-Yale Joint Center for Biostatistics (Z.Y.), New Haven, CT. Schaturvedi@med.miami.edu. 2. From the Miami VA Hospital (S.C.); Department of Neurology (S.C.), University of Miami Miller School of Medicine, FL; Departments of Biostatistics (S.O., F.B.), Internal Medicine (L.J.M., T.D., D.B.), Emergency Medicine (E.M.), and Neurology (L.S.W., D.B.), Indiana University School of Medicine, IUPUI; Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Stroke Quality Enhancement Research Initiative (QUERI) (L.J.M., T.D., E.M., M.R., L.S.W., G.A., D.B.); VA HSR&D Center for Health Information and Communication (CHIC) (L.J.M., T.D., E.M., L.S.W., D.B.), Richard L. Roudebush VA Medical Center, Indianapolis, IN; Department of Neurology (M.P.), University of Maryland School of Medicine, Baltimore; Clinical Epidemiology Research Center (J.J.S.), VA Connecticut Healthcare System, West Haven; Departments of Internal Medicine and Neurology (J.J.S.), Yale University School of Medicine, New Haven, CT; Regenstrief Institute (T.D., E.M., L.S.W., D.B.), Indianapolis, IN; Department of Epidemiology (M.R.), Michigan State University, East Lansing; VA Nebraska-Western Iowa Health Care System-Omaha Division (J.J.), Omaha; Department of Surgery (J.J.), University of Nebraska, Lincoln; Purdue University School of Nursing (G.A.), West Lafayette, IN; Department of Neurology (E.C.), University of California, Los Angeles School of Medicine; and SJTU-Yale Joint Center for Biostatistics (Z.Y.), New Haven, CT.
Abstract
BACKGROUND: Use of MRI with diffusion-weighted imaging (DWI) can identify infarcts in 30%-50% of patients with TIA. Previous guidelines have indicated that MRI-DWI is the preferred imaging modality for patients with TIA. We assessed the frequency of MRI utilization and predictors of MRI performance. METHODS: A review of TIA and minor stroke patients evaluated at Veterans Affairs hospitals was conducted with regard to medical history, use of diagnostic imaging within 2 days of presentation, and in-hospital care variables. Chart abstraction was performed in a subset of hospitals to assess clinical variables not available in the administrative data. RESULTS: A total of 7,889 patients with TIA/minor stroke were included. Overall, 6,694 patients (84.9%) had CT or MRI, with 3,396/6,694 (50.7%) having MRI. Variables that were associated with increased odds of CT performance were age >80 years, prior stroke, history of atrial fibrillation, heart failure, coronary artery disease, anxiety, and low hospital complexity, while blood pressure >140/90 mm Hg and high hospital complexity were associated with increased likelihood of MRI. Diplopia (87% had MRI, p = 0.03), neurologic consultation on the day of presentation (73% had MRI, p < 0.0001), and symptom duration of >6 hours (74% had MRI, p = 0.0009) were associated with MRI performance. CONCLUSIONS: Within a national health system, about 40% of patients with TIA/minor stroke had MRI performed within 2 days. Performance of MRI appeared to be influenced by several patient and facility-level variables, suggesting that there has been partial acceptance of the previous guideline that endorsed MRI for patients with TIA.
BACKGROUND: Use of MRI with diffusion-weighted imaging (DWI) can identify infarcts in 30%-50% of patients with TIA. Previous guidelines have indicated that MRI-DWI is the preferred imaging modality for patients with TIA. We assessed the frequency of MRI utilization and predictors of MRI performance. METHODS: A review of TIA and minor stroke patients evaluated at Veterans Affairs hospitals was conducted with regard to medical history, use of diagnostic imaging within 2 days of presentation, and in-hospital care variables. Chart abstraction was performed in a subset of hospitals to assess clinical variables not available in the administrative data. RESULTS: A total of 7,889 patients with TIA/minor stroke were included. Overall, 6,694 patients (84.9%) had CT or MRI, with 3,396/6,694 (50.7%) having MRI. Variables that were associated with increased odds of CT performance were age >80 years, prior stroke, history of atrial fibrillation, heart failure, coronary artery disease, anxiety, and low hospital complexity, while blood pressure >140/90 mm Hg and high hospital complexity were associated with increased likelihood of MRI. Diplopia (87% had MRI, p = 0.03), neurologic consultation on the day of presentation (73% had MRI, p < 0.0001), and symptom duration of >6 hours (74% had MRI, p = 0.0009) were associated with MRI performance. CONCLUSIONS: Within a national health system, about 40% of patients with TIA/minor stroke had MRI performed within 2 days. Performance of MRI appeared to be influenced by several patient and facility-level variables, suggesting that there has been partial acceptance of the previous guideline that endorsed MRI for patients with TIA.
Authors: Aine Merwick; Gregory W Albers; Pierre Amarenco; Ethem M Arsava; Hakan Ay; David Calvet; Shelagh B Coutts; Brett L Cucchiara; Andrew M Demchuk; Karen L Furie; Matthew F Giles; Julien Labreuche; Philippa C Lavallée; Jean-Louis Mas; Jean Marc Olivot; Francisco Purroy; Peter M Rothwell; Jeffrey L Saver; Orla C Sheehan; John P Stack; Cathal Walsh; Peter J Kelly Journal: Lancet Neurol Date: 2010-10-11 Impact factor: 44.182
Authors: Shelagh B Coutts; Jayesh Modi; Shiel K Patel; Andrew M Demchuk; Mayank Goyal; Michael D Hill Journal: Stroke Date: 2012-02-02 Impact factor: 7.914
Authors: M F Giles; G W Albers; P Amarenco; E M Arsava; A W Asimos; H Ay; D Calvet; S B Coutts; B L Cucchiara; A M Demchuk; S C Johnston; P J Kelly; A S Kim; J Labreuche; P C Lavallee; J-L Mas; A Merwick; J M Olivot; F Purroy; W D Rosamond; R Sciolla; P M Rothwell Journal: Neurology Date: 2011-08-24 Impact factor: 9.910
Authors: Shelagh B Coutts; Jessica E Simon; Michael Eliasziw; Chul-Ho Sohn; Michael D Hill; Philip A Barber; Vanessa Palumbo; James Kennedy; Jayanta Roy; Alexis Gagnon; James N Scott; Alastair M Buchan; Andrew M Demchuk Journal: Ann Neurol Date: 2005-06 Impact factor: 10.422
Authors: Shadi Yaghi; Sara K Rostanski; Amelia K Boehme; Sheryl Martin-Schild; Alyana Samai; Brian Silver; Christina A Blum; Mahesh V Jayaraman; Matthew S Siket; Muhib Khan; Karen L Furie; Mitchell S V Elkind; Randolph S Marshall; Joshua Z Willey Journal: JAMA Neurol Date: 2016-05-01 Impact factor: 18.302
Authors: J Donald Easton; Jeffrey L Saver; Gregory W Albers; Mark J Alberts; Seemant Chaturvedi; Edward Feldmann; Thomas S Hatsukami; Randall T Higashida; S Claiborne Johnston; Chelsea S Kidwell; Helmi L Lutsep; Elaine Miller; Ralph L Sacco Journal: Stroke Date: 2009-05-07 Impact factor: 7.914
Authors: James F Burke; Douglas J Gelb; Douglas J Quint; Lewis B Morgenstern; Kevin A Kerber Journal: J Eval Clin Pract Date: 2012-11-22 Impact factor: 2.431
Authors: J B Fiebach; P D Schellinger; O Jansen; M Meyer; P Wilde; J Bender; P Schramm; E Jüttler; J Oehler; M Hartmann; S Hähnel; M Knauth; W Hacke; K Sartor Journal: Stroke Date: 2002-09 Impact factor: 7.914
Authors: Hebun Erdur; Lennart S Milles; Jan F Scheitz; Kersten Villringer; Karl Georg Haeusler; Matthias Endres; Heinrich J Audebert; Jochen B Fiebach; Christian H Nolte Journal: Eur Radiol Date: 2018-08-23 Impact factor: 5.315
Authors: Daniel Puhr-Westerheide; Matthias F Froelich; Olga Solyanik; Eva Gresser; Paul Reidler; Matthias P Fabritius; Matthias Klein; Konstantin Dimitriadis; Jens Ricke; Clemens C Cyran; Wolfgang G Kunz; Philipp M Kazmierczak Journal: Eur Radiol Date: 2021-08-28 Impact factor: 5.315