Harmouche Elie, Mahmoud Ghada A, Ross Michael, Hockenberry Jason, Dharia Robin, Nahab Fadi
Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI; Department of Emergency Medicine, Emory University, Atlanta, GA.
Department of Neurology, Ain Shams University, Cairo, Egypt.
J Stroke Cerebrovasc Dis. 2017 Aug;26(8):1858-1863. doi: 10.1016/j.jstrokecerebrovasdis.2017.04.022. Epub 2017 May 11.
Current guidelines recommend patients presenting with transient ischemic attack (TIA) undergo echocardiography to evaluate for a cardiac source. However, echocardiography is not available daily at many centers. We assessed the yield from early transthoracic echocardiography (TTE) in consecutive patients with TIA evaluated in an emergency department observation unit (EDOU) protocol.
This observational cohort study took place in an academic medical center from January 1, 2011 to July 31, 2013. Patients seen in the emergency department, assigned to the EDOU for a TIA accelerated diagnostic protocol and discharged with a diagnosis of TIA were included. We retrospectively collected baseline patient characteristics, ABCD2 score, neuroimaging, telemetry, TTE, and 3-month clinical outcomes.
Of 236 subjects (mean age 62 ± 15 years, 68% female, 57% African American, 17% with history of stroke, 27% with history of cardiac disease, mean ABCD2 score 3.8 ± 1.5, mean EDOU length of stay 18.6 ± 6.2 hours), abnormal bedside cardiac examination was identified in 19 (8%) patients, abnormal electrocardiogram (ECG)/telemetry in 41 (17%), and abnormal TTE in 64 (27%), 41 of which suggested a patent foramen ovale. Among 136 (58%) patients with no previous cardiac disease or stroke, a normal bedside cardiac examination, and normal ECG/telemetry, TTE identified no high-risk cardiac causes.
In patients with TIA presenting to an EDOU with no previous cardiac disease or stroke, normal cardiac examination, and normal ECG/telemetry, early TTE had a low yield for identifying high-risk cardiac causes. In EDOUs where TTE is not available daily, outpatient TTE for this patient subgroup may be considered to limit prolonged lengths of stay.
当前指南建议短暂性脑缺血发作（TIA）患者接受超声心动图检查以评估心脏来源。然而，许多中心并非每天都能进行超声心动图检查。我们评估了在急诊科观察单元（EDOU）方案中连续的TIA患者早期经胸超声心动图（TTE）的诊断价值。
这项观察性队列研究于2011年1月1日至2013年7月31日在一家学术医疗中心进行。纳入在急诊科就诊、被分配到EDOU进行TIA加速诊断方案并出院诊断为TIA的患者。我们回顾性收集了患者的基线特征、ABCD2评分、神经影像学检查、遥测、TTE以及3个月的临床结局。
236名受试者（平均年龄62±15岁，68%为女性，57%为非裔美国人，17%有中风病史，27%有心脏病史，平均ABCD2评分为3.8±1.5，平均EDOU住院时间为18.6±6.2小时）中，19名（8%）患者床边心脏检查异常，41名（17%）患者心电图（ECG）/遥测异常，64名（27%）患者TTE异常，其中41名提示卵圆孔未闭。在136名（58%）既往无心脏病或中风、床边心脏检查正常且ECG/遥测正常的患者中，TTE未发现高危心脏病因。
对于既往无心脏病或中风、心脏检查正常且ECG/遥测正常的EDOU中的TIA患者，早期TTE发现高危心脏病因的概率较低。在并非每天都能进行TTE的EDOU中，对于该亚组患者可考虑门诊TTE以限制住院时间延长。
