BACKGROUND: The management of patients with acute transient ischemic attack (TIA) or minor stroke is highly variable. Whether hospitalization of such patients significantly improves short-term clinical outcome is unknown. We assessed the short-term clinical outcome associated with inpatient versus outpatient management of patients with TIA or minor stroke. METHODS: We evaluated a consecutive series of patients with acute TIA or minor ischemic stroke (NIH Stroke Scale score ≤ 3) presenting to a single emergency department (ED). We randomized patients to either hospital-based or outpatient-based management. All patients underwent interview and examination 7-10 days following the index event. RESULTS: This study included 100 patients, 41 with TIA and 59 with minor stroke. Nineteen (46%) of the TIA patients and 29 (49%) of the minor stroke patients randomized to hospital management, and the remaining 22 TIA patients and 30 minor stroke patients randomized to outpatient-based management. In the patients with a minor stroke, neurologic worsening occurred in 6 out of 29 (21%) in the inpatient arm compared with 3 out of 30 (10%) in the outpatient arm (p = 0.3). In none of these cases was acute interventional therapy or need for urgent admission considered medically appropriate. In the patients with a TIA, recurrence of a TIA occurred in 2 out of 19 (11%) in the inpatient arm compared with 2 out of 22 (9%) in the outpatient arm (p = 1). None of the patients with a TIA randomized to the inpatient arm experienced a stroke compared with 1 out of 22 in the outpatient arm (p = 1). There were no deaths in either group. CONCLUSION: Routine hospitalization of all patients with TIA or minor ischemic stroke may not positively affect short-term clinical outcome.
RCT Entities:
BACKGROUND: The management of patients with acute transient ischemic attack (TIA) or minor stroke is highly variable. Whether hospitalization of such patients significantly improves short-term clinical outcome is unknown. We assessed the short-term clinical outcome associated with inpatient versus outpatient management of patients with TIA or minor stroke. METHODS: We evaluated a consecutive series of patients with acute TIA or minor ischemic stroke (NIH Stroke Scale score ≤ 3) presenting to a single emergency department (ED). We randomized patients to either hospital-based or outpatient-based management. All patients underwent interview and examination 7-10 days following the index event. RESULTS: This study included 100 patients, 41 with TIA and 59 with minor stroke. Nineteen (46%) of the TIApatients and 29 (49%) of the minor strokepatients randomized to hospital management, and the remaining 22 TIApatients and 30 minor strokepatients randomized to outpatient-based management. In the patients with a minor stroke, neurologic worsening occurred in 6 out of 29 (21%) in the inpatient arm compared with 3 out of 30 (10%) in the outpatient arm (p = 0.3). In none of these cases was acute interventional therapy or need for urgent admission considered medically appropriate. In the patients with a TIA, recurrence of a TIA occurred in 2 out of 19 (11%) in the inpatient arm compared with 2 out of 22 (9%) in the outpatient arm (p = 1). None of the patients with a TIA randomized to the inpatient arm experienced a stroke compared with 1 out of 22 in the outpatient arm (p = 1). There were no deaths in either group. CONCLUSION: Routine hospitalization of all patients with TIA or minor ischemic stroke may not positively affect short-term clinical outcome.
Entities:
Keywords:
Transient ischemic attack (TIA); minor stroke; stroke bridge clinic
Authors: Fadi Nahab; George Leach; Carlene Kingston; Osman Mir; Jerome Abramson; Sarah Hilton; Matthew Keadey; Bryce Gartland; Michael Ross Journal: J Stroke Cerebrovasc Dis Date: 2011-04-09 Impact factor: 2.136
Authors: Dawn Kleindorfer; Peter Panagos; Arthur Pancioli; Jane Khoury; Brett Kissela; Daniel Woo; Alexander Schneider; Kathleen Alwell; Edward Jauch; Rosie Miller; Charles Moomaw; Rakesh Shukla; Joseph P Broderick Journal: Stroke Date: 2005-02-24 Impact factor: 7.914
Authors: Joanna M Wardlaw; Miriam Brazzelli; Francesca M Chappell; Hector Miranda; Kirsten Shuler; Peter A G Sandercock; Martin S Dennis Journal: Neurology Date: 2015-07-01 Impact factor: 9.910