Short-term prognosis after emergency department diagnosis of TIA

Context Management of patients with acute transient ischemic attack (TIA) v aries widely, with some institutions admitting all patients and others proc eeding with outpatient evaluations. Defining the short-term prognosis and r isk factors for stroke after TIA may provide guidance in determining which patients need rapid evaluation. Objective To determine the short-term risk of stroke and other adverse even ts after emergency department (ED) diagnosis of TIA. Design and Setting Cohort study conducted from March 1997 through February 1998 in 16 hospitals in a health maintenance organization in northern Calif ornia. Patients A total of 1707 patients (mean age, 72 years) identified by ED phy sicians as having presented with TIA. Main Outcome Measures Risk of stroke during the 90 days after index TIA; ot her events, including death, recurrent TIA, and hospitalization for cardiov ascular events. Results During the 90 days after index TIA, 180 patients (10.5%) returned t o the ED with a stroke, 91 of which occurred in the first 2 days. Five fact ors were independently associated with stroke: age greater than 60 years (o dds ratio [OR], 1.8; 95% confidence interval [CI], 1.1-2.7; P=.01), diabete s mellitus (OR, 2.0; 95% CI, 1.4-2.9; P<.001), symptom duration longer than 10 minutes (OR, 2.3; 95% CI, 1.3-4.2; P=.005), weakness (OR, 1.9, 95% CI, 1.4-2.6; P<.001), and speech impairment (OR, 1.5, 95% CI, 1.1-2.1; P=.01). Stroke or other adverse events occurred in 428 patients (25.1%) in the 90 d ays after the TIA and included 44 hospitalizations for cardiovascular event s (2.6%), 45 deaths (2.6%), and 216 recurrent TIAs (12.7%). Conclusions Our results indicate that the short-term risk of stroke and oth er adverse events among patients who present to an ED with a TIA is substan tial. Characteristics of the patient and the TIA may be useful for identify ing patients who may benefit from expeditious evaluation and treatment.