Impact of Hospital Admission for Patients with Transient Ischemic Attack.

Cheng EM, Myers LJ, Vassar S, Bravata DM. Impact of Hospital Admission for Patients with Transient Ischemic Attack. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2017 Aug 1; 26(8):1831-1840.

Related HSR&D Project(s)

• RRP 10-055 – Management and Outcomes of Veterans with Transient Ischemic Attack

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Abstract:

OBJECTIVES: To determine the impact of admission among transient ischemic attack (TIA) patients in the emergency department (ED). STUDY DESIGN: Retrospective cohort study using national Veterans Health Administration data (2008). METHODS: We first analyzed whether admitted patients were discharged from the hospital with a diagnosis of TIA. We then analyzed whether admission was associated with a composite outcome (new stroke, new myocardial infarction, or death in the year after TIA) using multivariate logistic regression modeling with propensity score matching. RESULTS: Among 3623 patients assigned a diagnosis of TIA in the ED, 2118 (58%) were admitted to the hospital or placed in observation compared with 1505 (42%) who were discharged from the ED. Among the 2118 patients who were admitted, 903 (43% of admitted group) were discharged from the hospital with a diagnosis of TIA, and 548 (26% of admitted group) were discharged with a diagnosis of stroke. Admitted patients were more likely than nonadmitted patients to receive processes of care (i.e., brain imaging, carotid imaging, echocardiography). In matched analyses using propensity scores, the 1-year composite outcome in the admitted group (15.3%) was not lower than the discharged group (13.3%, OR 1.17 [.94-1.46], P? = .17). CONCLUSIONS: Less than half of patients admitted with a diagnosis of TIA retained that diagnosis at hospital discharge. Although admitted patients were more likely to receive diagnostic procedures, we did not identify improvements in outcomes among admitted patients; however, evaluating care for patients with TIA is limited by the reliability of secondary data analysis.