Authors (including presenting author) :
CHIU LH(1), WONG CL(1)
Affiliation :
(1) Accident and Emergency Medicine, Princess Margaret Hosptial
Introduction :
Controversies do exist whether hospitalization is warranted for most TIA patients, decision in the acute management in the Accident & Emergency Department (AED) varies from inpatient care in Acute Stroke Unit (ASU) to referral to outpatient care. In HA, Emergency Ward (EMW) is designed for expected short length of stay (LOS). We admitted TIA patients to EMW according to a protocol agreed with Neurologist, for fast track treatment, investigations, and close neurological observation. We anticipated this triage system would minimise hospitalization in medical ward or ASU.
Objectives :
The short term stroke risk of Chinese patient with TIA managed in an Emergency Department. To study the safety of management of TIA patient in the Emergency Medicine Ward
Methodology :
The Princess Margaret Hospital (PMH), with annual AED attendance of 140K, is a major regional hospital serving a population of 1M in the Western Kowloon and Tsuen Wan area. In 2011, the PMH ASU provides 9am to 5pm thrombolytic for patient with acute strokes. All TIA cases diagnosed in Emergency Department in the period 1 Oct 2011 to 31 Mar 2013. A TIA management protocol agreed between the AED and the Neurologist followed. Our study used prospective, consecutive, sample cohort enrollment, followed by review of all hard copies and electronic medical records of all concerned Departments, including TIA clinic and further outpatient follow-up up to 1 year from the index TIA.
Result & Outcome :
124 of the 143 clinically diagnosed TIA cases were included in the analysis. Of the 113 admitted to EM ward, 13 cases were transferred to medical ward for recurring of symptoms, prolonged stay due to other comorbidities or social reasons. 11 cases were admitted to Medical Ward direct. 5 patients developed a stroke within 90 days at Day 2, 5, 6, 13, and 37 after ED arrival. No further strokes occurred within 1 year (Table 1). The accumulated stroke risk of the 124 TIA at 2,7, 90 days were 0.8%, 2.4%, and 4.0% respectively, comparable to the risk stroke in one HK study 2014. The patient who had a stroke within 2 days, with ABCD2 score 4, developed stroke within one day after EMW admission, was transferred to medical ward and further hospitalised for 11.5 days. One patient, ABCD2 score 2, with history of AF, had a stroke with frontal lobe infarct on day 13, before the TIA clinic appointment, and died of pneumonia at day 87 after the index TIA. She was not anticoagulated on discharge, only aspirin was started. The short term stroke risk after a TIA is associated with AF (chi-square p= 0.0007), but not associated with ABCD2 score (chi-square p= 0.9820), with score <=3 considered as low risk, ABCD2 <=3 (n=3), >=4 (n=2) (Table 2). LOS in EMW (Table 4,5).
Co-location with:
