Can risk stratification of transient ischaemic attacks improve patient care in the emergency department?

INTRODUCTION

The ABCD scoring system has been described as a simple way of predicting stroke in the first 7 days after a transient ischaemic attack (TIA). The aims of our pilot study were to find out if emergency department (ED) doctors could use the scoring system effectively and if this system would influence admission rates and patient selection.

METHOD

The ED notes were reviewed over a 3-month period. The ABCD (age, blood pressure, clinical features, duration) scoring system was retrospectively applied to each patient who presented with a TIA (pre-education (Pre) group). Doctors were then educated on the use of the scoring system, and the system was used for a further 3 months. Patients with high scores were admitted, and those with low scores were reviewed at the hospital's TIA clinic. The authors reviewed the notes retrospectively and each patient was scored again, based on the information available (post-education (Post) group). The number of appropriate admissions was compared using the chi2 test.

RESULTS

37 patients matched the inclusion criteria in the Pre group and 38 patients in the Post group. Baseline characteristics of the groups were similar. There was a significant reduction in the number of patients admitted in the Post group, but the appropriateness of the admission was significantly greater (p<0.01). There were no inappropriate discharges in the Post group.

CONCLUSIONS

The ABCD scoring system for identifying high-risk patients after TIA is a useful aid in determining which patients require admission from the ED. Its use results in a significant reduction in the number of admissions without any inappropriate discharges.