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Hospital and demographic factors influence emergency department triage of patients with mini-strokes

One of every 1,000 persons in the United States visits the emergency department (ED) for transient ischemic attack (TIA), a so-called mini-stroke. Since a TIA is a strong predictor of subsequent stroke and death, deciding who should be admitted to the hospital or sent home (ED triage) is important. Clinical factors, such as complicating cardiac conditions and whether the patient is already on anticoagulants, play a role in triage. Yet, hospital and demographic factors also influence the ED triage of these patients, finds a new study.

A TIA occurs when blood supply to part of the brain is briefly interrupted. These mini-strokes last only a few minutes, and most symptoms (which range from numbness or weakness in the face, arm, or leg to confusion, trouble seeing or walking, and dizziness) generally persist for less than 24 hours. Guidelines for managing ED patients with TIA call for a medical history and physical exam, electrocardiogram, routine blood work, and diagnostic brain imaging.

Jeffrey Coben, M.D. and Todd J. Crocco, M.D., at West Virginia University, and Agency for Healthcare Research and Quality researchers, Pamela L. Owens, Ph.D., and Claudia A. Steiner, M.D., M.P.H., looked at all 38,843 ED-treated TIA cases from community hospitals in 11 States. These cases were identified from the 2002 Healthcare Cost and Utilization Project. Over half (53 percent) of these patients were admitted to the hospital, while 47 percent were discharged home.

Clinical characteristics were important to ED triage, with patients with complicating cardiac conditions more likely to be admitted, for example. However, after controlling for these clinical factors, hospital and sociodemographic characteristics also played a role in ED triage. For example, patients living in more rural communities and arriving at smaller hospitals were more likely to be discharged home from the ED. Also, women were more likely to be admitted than men, as were those evaluated on weekends than those seen during weekdays, and those with Medicare instead of private or no health insurance.

See "Hospital and demographic influences on the disposition of transient ischemic attack," by Drs. Coben, Owens, Steiner, and Crocco, in the February 2008 Academic Emergency Medicine 15, pp. 171-176.

Reprints (AHRQ Publication No. 08-R063) are available from the AHRQ Publications Clearinghouse.

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