Emergency Medicine, Columbia University Medical Center, New York, New York, USA
Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York, USA.
Emerg Med J. 2020 Aug;37(8):486-488. doi: 10.1136/emermed-2019-209154. Epub 2020 Jan 28.
Recent evidence suggests clinical equipoise for managing transient ischaemic attack and minor stroke (TIAMS) either via discharge from the emergency department (ED) with rapid outpatient follow-up or inpatient admission. Understanding patient preferences may guide decision-making around disposition after TIAMS that can lead to higher patient satisfaction and adherence. Psychological distress, particularly a sense of vulnerability (eg, 'threat perception') is associated with adverse psychological outcomes following TIAMS and may influence patient disposition preference. We hypothesised patients with higher threat perceptions in the ED would prefer inpatient admission versus early discharge with rapid outpatient follow-up.
This was a planned secondary analysis of a prospective observational cohort study of ED patients with suspected TIAMS (defined as National Institutes of Health Stroke Scale (NIHSS) score of ≤5). Patients reported disposition preferences and completed a validated scale of threat perception while in the ED (score range: 1-4).
147 TIAMS patients were evaluated (mean age: 59.7±15.4, 45.6% female, 39.5% Hispanic, median NIHSS=1, IQR: 0, 3). A majority of patients (98, 66.7%) preferred inpatient admission compared with discharge from the ED. Overall threat scores were median 1.0 (IQR: 0.43, 1.68). Those preferring admission had similar threat scores compared with those who preferred early disposition (median: 1.00, IQR: 0.43, 1.57) versus 1.00, (IQR: 0.49, 1.68); p=0.40). In a model adjusted for demographic characteristics, threat perceptions remained unassociated with disposition preference.
Overall, two-thirds of TIAMS patients preferred inpatient admission over discharge. Disposition preference was not associated with higher threat perception in the ED. Further research examining potential drivers of patient disposition preferences may inform patient discussions and optimise patient satisfaction.
最近的证据表明，对于短暂性脑缺血发作和小卒中（TIAMS）的管理，无论是通过从急诊室（ED）出院并进行快速门诊随访，还是住院治疗，临床平衡均存在。了解患者的偏好可能有助于指导 TIAMS 后的处置决策，从而提高患者的满意度和依从性。心理困扰，尤其是脆弱感（例如，“威胁感知”）与 TIAMS 后的不良心理结局相关，并且可能影响患者的处置偏好。我们假设 ED 中威胁感知较高的患者会更倾向于住院治疗，而不是快速门诊随访出院。
这是一项对疑似 TIAMS 的 ED 患者进行前瞻性观察队列研究的计划二次分析（定义为 NIHSS 评分≤5）。患者在 ED 时报告了处置偏好，并完成了威胁感知的验证量表（评分范围：1-4）。
共评估了 147 名 TIAMS 患者（平均年龄：59.7±15.4，45.6%为女性，39.5%为西班牙裔，中位数 NIHSS=1，IQR：0，3）。大多数患者（98 例，66.7%）更喜欢住院治疗，而不是从 ED 出院。总体威胁评分中位数为 1.0（IQR：0.43，1.68）。与更喜欢早期处置的患者相比，选择住院治疗的患者的威胁评分相似（中位数：1.00，IQR：0.43，1.57）与 1.00，（IQR：0.49，1.68）；p=0.40）。在调整人口统计学特征的模型中，威胁感知与处置偏好无关。
总体而言，三分之二的 TIAMS 患者更喜欢住院治疗而不是出院。处置偏好与 ED 中的高威胁感知无关。进一步研究检查患者处置偏好的潜在驱动因素可能有助于患者讨论并优化患者满意度。
