Bibok Maximilian B, Votova Kristine, Balshaw Robert F, Lesperance Mary L, Croteau Nicole S, Trivedi Anurag, Morrison Jaclyn, Sedgwick Colin, Penn Andrew M
Department of Research & Capacity Building, Island Health, 1952 Bay Street, Victoria, BC, V8R 1J8, Canada.
Division of Medical Sciences & Island Medical Program, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada.
BMC Health Serv Res. 2018 Feb 27;18(1):142. doi: 10.1186/s12913-018-2952-x.
To evaluate the performance of a novel triage system for Transient Ischemic Attack (TIA) units built upon an existent clinical prediction rule (CPR) to reduce time to unit arrival, relative to the time of symptom onset, for true TIA and minor stroke patients. Differentiating between true and false TIA/minor stroke cases (mimics) is necessary for effective triage as medical intervention for true TIA/minor stroke is time-sensitive and TIA unit spots are a finite resource.
Prospective cohort study design utilizing patient referral data and TIA unit arrival times from a regional fast-track TIA unit on Vancouver Island, Canada, accepting referrals from emergency departments (ED) and general practice (GP). Historical referral cohort (N = 2942) from May 2013-Oct 2014 was triaged using the ABCD2 score; prospective referral cohort (N = 2929) from Nov 2014-Apr 2016 was triaged using the novel system. A retrospective survival curve analysis, censored at 28 days to unit arrival, was used to compare days to unit arrival from event date between cohort patients matched by low (0-3), moderate (4-5) and high (6-7) ABCD2 scores.
Survival curve analysis indicated that using the novel triage system, prospectively referred TIA/minor stroke patients with low and moderate ABCD2 scores arrived at the unit 2 and 1 day earlier than matched historical patients, respectively.
The novel triage process is associated with a reduction in time to unit arrival from symptom onset for referred true TIA/minor stroke patients with low and moderate ABCD2 scores.
评估一种基于现有临床预测规则（CPR）构建的新型分诊系统在短暂性脑缺血发作（TIA）单元的性能，以缩短真正的TIA和轻度卒中患者从症状发作到到达单元的时间。区分真正的和假性TIA/轻度卒中病例（模拟病例）对于有效分诊是必要的，因为针对真正的TIA/轻度卒中的医疗干预具有时间敏感性，且TIA单元床位是有限资源。
采用前瞻性队列研究设计，利用加拿大温哥华岛一个区域快速通道TIA单元的患者转诊数据和TIA单元到达时间，该单元接受急诊科（ED）和全科医疗（GP）的转诊。2013年5月至2014年10月的历史转诊队列（N = 2942）采用ABCD2评分进行分诊；2014年11月至2016年4月的前瞻性转诊队列（N = 2929）采用新型系统进行分诊。采用回顾性生存曲线分析，以到达单元的28天为截尾时间，比较低（0 - 3）、中（4 - 5）和高（6 - 7）ABCD2评分匹配的队列患者从事件日期到单元到达的天数。
生存曲线分析表明，使用新型分诊系统，前瞻性转诊的低和中度ABCD2评分的TIA/轻度卒中患者分别比匹配的历史患者提前2天和1天到达单元。
对于转诊的低和中度ABCD2评分的真正TIA/轻度卒中患者，新型分诊流程与从症状发作到单元到达的时间缩短相关。
