Department of Neurology and Stroke Centre, La Paz University Hospital, IdiPAZ Health Research Institute, Autónoma University of Madrid, Madrid, Spain.
Eur J Neurol. 2013 Feb;20(2):338-43. doi: 10.1111/j.1468-1331.2012.03858.x. Epub 2012 Aug 29.
Clinics for early management of transient ischaemic attacks (TIAs) have been developed in some stroke centres, resulting in reduced recurrence rates compared to appointment-based outpatient management, thus saving on hospitalization. We analysed the care process, recurrence rates and economic impact of the first year of work in our early-management TIA clinic and compared these with our previous in-hospital study protocols for low- and moderate-risk TIA patients.
This was a prospective evaluation of the management of low- to moderate-risk TIA patients, comparing a new TIA clinic model (2010) with a previous hospitalization model (2009). Demographic data, vascular risk factor profiles, diagnostic test performance, secondary prevention measures, final aetiological diagnoses and cerebrovascular recurrences at 7 and 90 days were compared between in-hospital and TIA clinic assessed patients. We also carried out an economic comparison of the costs of each model's process.
Two hundred and eleven low- to moderate-risk TIA patients were included, of whom 40.8% were hospitalized. There were no differences between the TIA clinic assessed and in-hospital assessed patients in terms of risk factor diagnosis and secondary prevention measures. The stroke recurrence rate (2.4% vs. 1.2%; P = 0.65) was low and similar for both groups (CI 95%, 0.214-20.436; P = 0.52). Cost per patient was €393.28 for clinic versus €1931.18 for in-hospital management. Outpatient management resulted in a 77.8% reduction in hospitalizations.
Transient ischaemic attacks clinics are efficient for the early management of low- to moderate-risk TIA patients compared to in-hospital assessment, with no higher recurrence rates and at almost one-fifth the cost.
一些卒中中心设立了短暂性脑缺血发作（TIA）的早期管理诊所，与基于预约的门诊管理相比，复发率降低，从而节省了住院费用。我们分析了我们的早期管理 TIA 诊所第一年的治疗过程、复发率和经济影响，并与我们之前的低危和中危 TIA 患者住院研究方案进行了比较。
这是一项对低危到中危 TIA 患者管理的前瞻性评估，比较了新的 TIA 诊所模式（2010 年）和之前的住院模式（2009 年）。比较了住院和 TIA 诊所评估的患者之间的人口统计学数据、血管危险因素谱、诊断试验表现、二级预防措施、最终病因诊断和 7 天和 90 天的脑血管复发情况。我们还对两种模式的成本进行了经济比较。
共纳入 211 例低危到中危 TIA 患者，其中 40.8%住院。TIA 诊所评估和住院评估的患者在危险因素诊断和二级预防措施方面没有差异。两组的卒中复发率（2.4% vs. 1.2%；P = 0.65）均较低且相似（95%CI，0.214-20.436；P = 0.52）。每位患者的费用分别为诊所 393.28 欧元和住院管理 1931.18 欧元。门诊管理使住院率降低了 77.8%。
与住院评估相比，TIA 诊所对低危到中危 TIA 患者的早期管理更有效率，复发率没有增加，费用降低了近五分之四。
