Discipline of General Practice, University of Newcastle, Callaghan, NSW, Australia.
Int J Stroke. 2013 Oct;8 Suppl A100:81-9. doi: 10.1111/ijs.12014. Epub 2013 Mar 12.
Transient ischemic attacks and minor stroke entail considerable risk of completed stroke but this risk is reduced by prompt assessment and treatment. Risk can be stratified according to the ABCD2 prediction score. Current guidelines suggest specialist assessment and treatment within 24 h for high-risk event (ABCD2 score 4-7) and seven-days for low-risk event (ABCD2 score ≤ 3).
The study aims to establish paths to care and outcomes for patients referred by general practitioners and emergency departments to an Australian acute access transient ischemic attack service.
This is a prospective audit. Primary outcomes were time from event to referral, from referral to clinic appointment, and from event to appointment. ABCD2 score was calculated for each event. Time from event was modeled using Cox proportional hazards regression.
There were 231 clinic attendees (general practitioner: 127; emergency department: 104). Mean time from event to referral was 9.2 days (SD 23.7, median 2), from referral to being seen in the clinic was 13.6 days (SD 19.0, median 7), and from event to being seen in the clinic was 17.2 days (SD 27.1, median 10). Of low-risk patients, 38.5% were seen within seven-days of event. Of high-risk patients, 36.7% were seen within one-day. ABCD2 score was not a significant predictor of any time interval from event to clinic attendance. There were no completed strokes prior to clinic attendance.
Times from event to clinic assessment were in excess of current recommendations and risk stratification was suboptimal, though short-term outcomes were good. Improvements in referral mechanisms may enhance risk-stratification and triage.
短暂性脑缺血发作和小中风会导致较高的中风风险，但通过及时评估和治疗可以降低这种风险。风险可以根据 ABCD2 预测评分进行分层。目前的指南建议高危事件（ABCD2 评分 4-7）在 24 小时内进行专科评估和治疗，低危事件（ABCD2 评分≤3）在 7 天内进行。
本研究旨在确定由全科医生和急诊科转介至澳大利亚急性就诊短暂性脑缺血发作服务的患者的就诊路径和结局。
这是一项前瞻性审计。主要结局指标为从事件到转介、从转介到就诊预约以及从事件到预约的时间。为每个事件计算 ABCD2 评分。使用 Cox 比例风险回归模型对从事件到就诊的时间进行建模。
共有 231 名就诊者（全科医生：127 名；急诊科：104 名）。从事件到转介的平均时间为 9.2 天（SD 23.7，中位数 2），从转介到就诊的平均时间为 13.6 天（SD 19.0，中位数 7），从事件到就诊的平均时间为 17.2 天（SD 27.1，中位数 10）。低危患者中，38.5%在事件发生后 7 天内就诊。高危患者中，36.7%在 1 天内就诊。ABCD2 评分不是从事件到就诊时间的显著预测指标。就诊前无中风患者发生。
从事件到就诊评估的时间超过了目前的建议，风险分层不理想，但短期结局良好。改善转介机制可能会提高风险分层和分诊效果。
