Majidi Shahram, Leon Guerrero Christopher R, Burger Kathleen M, Rothrock John F
Department of Neurology, George Washington University School of Medicine, Washington, DC, USA.
J Vasc Interv Neurol. 2017 Jun;9(4):49-53.
The management of patients with acute transient ischemic attack (TIA) or minor stroke is highly variable. Whether hospitalization of such patients significantly improves short-term clinical outcome is unknown. We assessed the short-term clinical outcome associated with inpatient versus outpatient management of patients with TIA or minor stroke.
We evaluated a consecutive series of patients with acute TIA or minor ischemic stroke (NIH Stroke Scale score ≤ 3) presenting to a single emergency department (ED). We randomized patients to either hospital-based or outpatient-based management. All patients underwent interview and examination 7-10 days following the index event.
This study included 100 patients, 41 with TIA and 59 with minor stroke. Nineteen (46%) of the TIA patients and 29 (49%) of the minor stroke patients randomized to hospital management, and the remaining 22 TIA patients and 30 minor stroke patients randomized to outpatient-based management. In the patients with a minor stroke, neurologic worsening occurred in 6 out of 29 (21%) in the inpatient arm compared with 3 out of 30 (10%) in the outpatient arm ( = 0.3). In none of these cases was acute interventional therapy or need for urgent admission considered medically appropriate. In the patients with a TIA, recurrence of a TIA occurred in 2 out of 19 (11%) in the inpatient arm compared with 2 out of 22 (9%) in the outpatient arm ( = 1). None of the patients with a TIA randomized to the inpatient arm experienced a stroke compared with 1 out of 22 in the outpatient arm ( = 1). There were no deaths in either group.
Routine hospitalization of all patients with TIA or minor ischemic stroke may not positively affect short-term clinical outcome.
急性短暂性脑缺血发作（TIA）或轻度卒中患者的管理差异很大。此类患者住院是否能显著改善短期临床结局尚不清楚。我们评估了TIA或轻度卒中患者住院治疗与门诊治疗相关的短期临床结局。
我们评估了连续一系列到单一急诊科就诊的急性TIA或轻度缺血性卒中（美国国立卫生研究院卒中量表评分≤3）患者。我们将患者随机分为住院治疗组或门诊治疗组。所有患者在索引事件发生后7 - 10天接受访谈和检查。
本研究纳入100例患者，41例为TIA患者，59例为轻度卒中患者。随机分配到住院治疗组的TIA患者有19例（46%），轻度卒中患者有29例（49%），其余22例TIA患者和30例轻度卒中患者随机分配到门诊治疗组。在轻度卒中患者中，住院组29例中有6例（21%）出现神经功能恶化，而门诊组30例中有3例（10%）出现神经功能恶化（P = 0.3）。在这些病例中，均未认为急性介入治疗或紧急入院是医学上合适的。在TIA患者中，住院组19例中有2例（11%）出现TIA复发，而门诊组22例中有2例（9%）出现TIA复发（P = 1）。随机分配到住院组的TIA患者均未发生卒中，而门诊组22例中有1例发生卒中（P = 1）。两组均无死亡病例。
所有TIA或轻度缺血性卒中患者常规住院治疗可能不会对短期临床结局产生积极影响。
