Cheng Eric M, Myers Laura J, Vassar Stefanie, Bravata Dawn M
Department of Neurology, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
VA Health Services Research & Development (HSR&D) Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, Indianapolis, Indiana; Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
J Stroke Cerebrovasc Dis. 2017 Aug;26(8):1831-1840. doi: 10.1016/j.jstrokecerebrovasdis.2017.04.018. Epub 2017 May 10.
To determine the impact of admission among transient ischemic attack (TIA) patients in the emergency department (ED).
Retrospective cohort study using national Veterans Health Administration data (2008).
We first analyzed whether admitted patients were discharged from the hospital with a diagnosis of TIA. We then analyzed whether admission was associated with a composite outcome (new stroke, new myocardial infarction, or death in the year after TIA) using multivariate logistic regression modeling with propensity score matching.
Among 3623 patients assigned a diagnosis of TIA in the ED, 2118 (58%) were admitted to the hospital or placed in observation compared with 1505 (42%) who were discharged from the ED. Among the 2118 patients who were admitted, 903 (43% of admitted group) were discharged from the hospital with a diagnosis of TIA, and 548 (26% of admitted group) were discharged with a diagnosis of stroke. Admitted patients were more likely than nonadmitted patients to receive processes of care (i.e., brain imaging, carotid imaging, echocardiography). In matched analyses using propensity scores, the 1-year composite outcome in the admitted group (15.3%) was not lower than the discharged group (13.3%, OR 1.17 [.94-1.46], P = .17).
Less than half of patients admitted with a diagnosis of TIA retained that diagnosis at hospital discharge. Although admitted patients were more likely to receive diagnostic procedures, we did not identify improvements in outcomes among admitted patients; however, evaluating care for patients with TIA is limited by the reliability of secondary data analysis.
确定急诊科短暂性脑缺血发作（TIA）患者入院的影响。
使用2008年退伍军人健康管理局全国数据进行的回顾性队列研究。
我们首先分析入院患者出院时是否诊断为TIA。然后，我们使用倾向评分匹配的多变量逻辑回归模型分析入院是否与复合结局（TIA后一年内新发中风、新发心肌梗死或死亡）相关。
在急诊科被诊断为TIA的3623例患者中，2118例（58%）入院或留观，1505例（42%）从急诊科出院。在2118例入院患者中，903例（入院组的43%）出院时诊断为TIA，548例（入院组的26%）出院时诊断为中风。入院患者比未入院患者更有可能接受护理流程（即脑部成像、颈动脉成像、超声心动图）。在使用倾向评分的匹配分析中，入院组的1年复合结局（15.3%）不低于出院组（13.3%，OR 1.17[.94 - 1.46]，P = 0.17）。
诊断为TIA入院的患者中，不到一半在出院时仍保留该诊断。虽然入院患者更有可能接受诊断程序，但我们并未发现入院患者的结局有所改善；然而，对TIA患者护理的评估受到二次数据分析可靠性的限制。
