Maximilian B Bibok1, Kristine Votova1, Robert F Balshaw2, Melanie Penn1, Mary L Lesperance3, Devin R Harris4, Colin Sedgwick5, Madeline Nealis1, Brian Farrell6, John R Mathieson7, Andrew M Penn8. 1. *Departments of Research and Capacity Building,Island Health Authority,Victoria,BC. 2. ‡‡British Columbia Centre for Disease Control,Vancouver,BC. 3. **Department of Mathematics and Statistics,Island Health Authority,Victoria,BC. 4. §§Department of Emergency Medicine,Kelowna General Hospital,Kelowna,BC. 5. ††Division of Medical Sciences and Island Medical Program,University of Victoria,Victoria BC. 6. †Departments of Emergency Medicine,Island Health Authority,Victoria,BC. 7. ‡Departments of Medical Imaging,Island Health Authority,Victoria,BC. 8. §Departments of Neurosciences (Stroke Rapid Assessment Clinic),Island Health Authority,Victoria,BC.
Abstract
OBJECTIVES: The Canadian Stroke Best Practice Recommendations suggests that patients suspected of transient ischemic attack (TIA)/minor stroke receive urgent brain imaging, preferably computed tomography angiography (CTA). Yet, high requisition rates for non-cerebrovascular patients overburden limited radiological resources, putting patients at risk. We hypothesize that our clinical decision support tool (CDST) developed for risk stratification of TIA in the emergency department (ED), and which incorporates Canadian guidelines, could improve CTA utilization. METHODS: Retrospective study design with clinical information gathered from ED patient referrals to an outpatient TIA unit in Victoria, BC, from 2015-2016. Actual CTA orders by ED and TIA unit staff were compared to hypothetical CTA ordering if our CDST had been used in the ED upon patient arrival. RESULTS: For 1,679 referrals, clinicians ordered 954 CTAs. Our CDST would have ordered a total of 977 CTAs for these patients. Overall, this would have increased the number of imaged-TIA patients by 89 (10.1%) while imaging 98 (16.1%) fewer non-cerebrovascular patients over the 2-year period. Our CDST would have ordered CTA for 18 (78.3%) of the recurrent stroke patients in the sample. CONCLUSIONS: Our CDST could enhance CTA utilization in the ED for suspected TIA patients, and facilitate guideline-based stroke care. Use of our CDST would increase the number of TIA patients receiving CTA before ED discharge (rather than later at TIA units) and reduce the burden of imaging stroke mimics in radiological departments.
OBJECTIVES: The Canadian Stroke Best Practice Recommendations suggests that patients suspected of transient ischemic attack (TIA)/minor stroke receive urgent brain imaging, preferably computed tomography angiography (CTA). Yet, high requisition rates for non-cerebrovascular patients overburden limited radiological resources, putting patients at risk. We hypothesize that our clinical decision support tool (CDST) developed for risk stratification of TIA in the emergency department (ED), and which incorporates Canadian guidelines, could improve CTA utilization. METHODS: Retrospective study design with clinical information gathered from ED patient referrals to an outpatient TIA unit in Victoria, BC, from 2015-2016. Actual CTA orders by ED and TIA unit staff were compared to hypothetical CTA ordering if our CDST had been used in the ED upon patient arrival. RESULTS: For 1,679 referrals, clinicians ordered 954 CTAs. Our CDST would have ordered a total of 977 CTAs for these patients. Overall, this would have increased the number of imaged-TIA patients by 89 (10.1%) while imaging 98 (16.1%) fewer non-cerebrovascular patients over the 2-year period. Our CDST would have ordered CTA for 18 (78.3%) of the recurrent strokepatients in the sample. CONCLUSIONS: Our CDST could enhance CTA utilization in the ED for suspected TIA patients, and facilitate guideline-based stroke care. Use of our CDST would increase the number of TIA patients receiving CTA before ED discharge (rather than later at TIA units) and reduce the burden of imaging stroke mimics in radiological departments.
Authors: Ava L Liberman; Andrea R Lendaris; Natalie T Cheng; Nicole L Kaban; Sara K Rostanski; Charles Esenwa; Benjamin R Kummer; Daniel L Labovitz; Shyam Prabhakaran; Benjamin W Friedman Journal: Neurohospitalist Date: 2021-06-03
Authors: Jens-Christian Altenbernd; Razvan Gramada; Eugen Kessler; Jakob Skatulla; Eduard Geppert; Jens Eyding; Hannes Nordmeyer Journal: J Clin Med Date: 2022-09-26 Impact factor: 4.964