Bernard P Chang1, Sara Rostanski2, Joshua Willey3, Eliza C Miller3, Steven Shapiro3, Rachel Mehendale3, Benjamin Kummer3, Babak B Navi4, Mitchell S V Elkind5. 1. Department of Emergency Medicine, Columbia University Irving Medical Center, New York, NY. Electronic address: bpc2103@cumc.columbia.edu. 2. Department of Neurology, New York University Medical Center, New York, NY. 3. Department of Neurology, Columbia University Irving Medical Center, New York, NY. 4. Department of Neurology, Weill Cornell Medicine, New York, NY. 5. Department of Neurology, Columbia University Irving Medical Center, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
Abstract
STUDY OBJECTIVE: Although most transient ischemic attack and minor stroke patients in US emergency departments (EDs) are admitted, experience in other countries suggests that timely outpatient evaluation of transient ischemic attack and minor stroke can be safe. We assess the feasibility and safety of a rapid outpatient stroke clinic for transient ischemic attack and minor stroke: Rapid Access Vascular Evaluation-Neurology (RAVEN). METHODS: Transient ischemic attack and minor stroke patients presenting to the ED with a National Institutes of Health Stroke Scale score of 5 or less and nondisabling deficit were assessed for potential discharge to RAVEN with a protocol incorporating social and medical criteria. Outpatient evaluation by a vascular neurologist, including vessel imaging, was performed within 24 hours at the RAVEN clinic. Participants were evaluated for compliance with clinic attendance and 90-day recurrent transient ischemic attack and minor stroke and hospitalization rates. RESULTS: Between December 2016 and June 2018, 162 transient ischemic attack and minor stroke patients were discharged to RAVEN. One hundred fifty-four patients (95.1%) appeared as scheduled and 101 (66%) had a final diagnosis of transient ischemic attack and minor stroke. Two patients (1.3%) required hospitalization (one for worsening symptoms and another for intracranial arterial stenosis caused by zoster) at RAVEN evaluation. Among the 101 patients with confirmed transient ischemic attack and minor stroke, 18 (19.1%) had returned to an ED or been admitted at 90 days. Five were noted to have had recurrent neurologic symptoms diagnosed as transient ischemic attack (4.9%), whereas one had a recurrent stroke (0.9%). No individuals with transient ischemic attack and minor stroke died, and none received thrombolytics or thrombectomy, during the interval period. These 90-day outcomes were similar to historical published data on transient ischemic attack and minor stroke. CONCLUSION: Rapid outpatient management appears a feasible and safe strategy for transient ischemic attack and minor stroke patients evaluated in the ED, with recurrent stroke and transient ischemic attack rates comparable to historical published data.
STUDY OBJECTIVE: Although most transient ischemic attack and minor strokepatients in US emergency departments (EDs) are admitted, experience in other countries suggests that timely outpatient evaluation of transient ischemic attack and minor stroke can be safe. We assess the feasibility and safety of a rapid outpatientstroke clinic for transient ischemic attack and minor stroke: Rapid Access Vascular Evaluation-Neurology (RAVEN). METHODS: Transient ischemic attack and minor strokepatients presenting to the ED with a National Institutes of Health Stroke Scale score of 5 or less and nondisabling deficit were assessed for potential discharge to RAVEN with a protocol incorporating social and medical criteria. Outpatient evaluation by a vascular neurologist, including vessel imaging, was performed within 24 hours at the RAVEN clinic. Participants were evaluated for compliance with clinic attendance and 90-day recurrent transient ischemic attack and minor stroke and hospitalization rates. RESULTS: Between December 2016 and June 2018, 162 transient ischemic attack and minor strokepatients were discharged to RAVEN. One hundred fifty-four patients (95.1%) appeared as scheduled and 101 (66%) had a final diagnosis of transient ischemic attack and minor stroke. Two patients (1.3%) required hospitalization (one for worsening symptoms and another for intracranial arterial stenosis caused by zoster) at RAVEN evaluation. Among the 101 patients with confirmed transient ischemic attack and minor stroke, 18 (19.1%) had returned to an ED or been admitted at 90 days. Five were noted to have had recurrent neurologic symptoms diagnosed as transient ischemic attack (4.9%), whereas one had a recurrent stroke (0.9%). No individuals with transient ischemic attack and minor strokedied, and none received thrombolytics or thrombectomy, during the interval period. These 90-day outcomes were similar to historical published data on transient ischemic attack and minor stroke. CONCLUSION: Rapid outpatient management appears a feasible and safe strategy for transient ischemic attack and minor strokepatients evaluated in the ED, with recurrent stroke and transient ischemic attack rates comparable to historical published data.
Authors: Michael A Ross; Scott Compton; Patrick Medado; Maureen Fitzgerald; Philip Kilanowski; Brian J O'Neil Journal: Ann Emerg Med Date: 2007-05-09 Impact factor: 5.721
Authors: Philippa C Lavallée; Elena Meseguer; Halim Abboud; Lucie Cabrejo; Jean-Marc Olivot; Olivier Simon; Mikael Mazighi; Chantal Nifle; Philippe Niclot; Bertrand Lapergue; Isabelle F Klein; Eric Brochet; Philippe Gabriel Steg; Guy Lesèche; Julien Labreuche; Pierre-Jean Touboul; Pierre Amarenco Journal: Lancet Neurol Date: 2007-11 Impact factor: 44.182
Authors: Peter M Rothwell; Matthew F Giles; Arvind Chandratheva; Lars Marquardt; Olivia Geraghty; Jessica N E Redgrave; Caroline E Lovelock; Lucy E Binney; Linda M Bull; Fiona C Cuthbertson; Sarah J V Welch; Shelley Bosch; Faye C Alexander; Faye Carasco-Alexander; Louise E Silver; Sergei A Gutnikov; Ziyah Mehta Journal: Lancet Date: 2007-10-20 Impact factor: 79.321
Authors: S Claiborne Johnston; Peter M Rothwell; Mai N Nguyen-Huynh; Matthew F Giles; Jacob S Elkins; Allan L Bernstein; Stephen Sidney Journal: Lancet Date: 2007-01-27 Impact factor: 79.321
Authors: Bernard P Chang; Talea Cornelius; Joshua Willey; Donald Edmondson; Mitchell Sv Elkind; Ian M Kronish Journal: Emerg Med J Date: 2020-01-28 Impact factor: 2.740
Authors: Paul M Wechsler; Neal S Parikh; Linda A Heier; Evelyn Ruiz; Matthew E Fink; Babak B Navi; Halina White Journal: Neurohospitalist Date: 2021-03-29
Authors: Andy Lim; Shaloo Singhal; Philippa Lavallee; Pierre Amarenco; Peter M Rothwell; Gregory Albers; Mukul Sharma; Robert Brown; Annemarei Ranta; Mohana Maddula; Timothy Kleinig; Jesse Dawson; Mitchell S V Elkind; Maria Guarino; Shelagh B Coutts; Benjamin Clissold; Henry Ma; Thanh Phan Journal: J Stroke Cerebrovasc Dis Date: 2020-08-18 Impact factor: 2.136
Authors: Ramon Luengo-Fernandez; Linxin Li; Louise Silver; Sergei Gutnikov; Nicola C Beddows; Peter M Rothwell Journal: Stroke Date: 2021-10-28 Impact factor: 7.914
Authors: Ava L Liberman; Hui Zhang; Sara K Rostanski; Natalie T Cheng; Charles C Esenwa; Neil Haranhalli; Puneet Singh; Daniel L Labovitz; Richard B Lipton; Shyam Prabhakaran Journal: J Am Heart Assoc Date: 2021-05-31 Impact factor: 6.106
Authors: Steven D Shapiro; Amelia K Boehme; Bernard P Chang; Eliza C Miller; Joshua Willey; Mitchell S V Elkind Journal: Neurohospitalist Date: 2020-11-05