From the Department of Emergency Medicine, Cumming School of Medicine (M.L., E.L., C.P.), University of Calgary, Alberta, Canada.
Analytics, Data Integration, Measurement & Reporting Program, Alberta Health Services Analytics (J.M.S., N.M.).
Stroke. 2020 Jun;51(6):1820-1824. doi: 10.1161/STROKEAHA.119.027960. Epub 2020 May 13.
Background and Purpose- Multiple studies have shown the 90-day risk of stroke following an emergency department (ED) diagnosis of transient ischemic attack (TIA) or minor stroke is significant, with the greatest risk of recurrence being within the first 24 to 48 hours following initial symptom onset. This study explored regional differences in ED disposition, neuroimaging, and subsequent 90-day stroke risk of patients diagnosed with TIA or minor stroke in Alberta. Methods- We used administrative databases to identify ED visits, neuroimaging, and 90-day return visits for TIA or minor stroke in Alberta from April 2011 to March 2016 among adults ≥20 years of age and stratified them based on regions of presentation (Edmonton, Calgary, or nonmajor urban). Results- During the 5-year study period, 22 421 patients had index ED visits for TIA or minor stroke. All 3 regions had a similar number of ED visits for TIA/minor stroke; however, on index ED visit, Calgary had a higher proportion of computed tomographic angiography imaging (48.8%; <0.0001) compared with Edmonton (6.7%) and nonmajor urban region (5.7%) and higher proportion of discharged patients (83%; <0.0001) compared with Edmonton (77.7%) and nonmajor urban region (73.5%). The risk of admission for stroke within 90 days of discharge after index ED visit for TIA/minor stroke in Calgary (3.4%) was lower than Edmonton (4.5%) and the nonmajor urban region (4.6%; =0.002). Conclusions- This study demonstrates regional variation in computed tomographic angiography for neurovascular imaging of patients presenting to the ED for TIA/minor stroke and a possible association with frequency of index visit admission and 90-day readmission for the same problem.
背景与目的-多项研究表明，急诊科（ED）诊断短暂性脑缺血发作（TIA）或小卒中后 90 天内发生卒中的风险显著，初始症状发作后 24 至 48 小时内复发的风险最大。本研究探讨了在阿尔伯塔省，因 TIA 或小卒中就诊的患者在 ED 处置、神经影像学检查和随后 90 天内卒中风险方面的区域差异。方法-我们使用行政数据库，在 2011 年 4 月至 2016 年 3 月期间，确定了成年患者（≥20 岁）在 ED 就诊、神经影像学检查和 90 天内 TIA 或小卒中复诊的情况，并根据就诊地点（埃德蒙顿、卡尔加里或非主要城市）对他们进行了分层。结果-在 5 年的研究期间，有 22421 例患者因 TIA 或小卒中首次就诊于 ED。所有 3 个地区的 TIA/小卒中 ED 就诊次数相似；然而，在首次就诊时，卡尔加里行 CT 血管造影的比例较高（48.8%；<0.0001），而埃德蒙顿（6.7%）和非主要城市地区（5.7%）的比例较低，且出院患者的比例较高（83%；<0.0001），而埃德蒙顿（77.7%）和非主要城市地区（73.5%）的比例较低。与埃德蒙顿（4.5%）和非主要城市地区（4.6%）相比，卡尔加里因 TIA/小卒中首次就诊后 90 天内的卒中住院风险（3.4%）较低（=0.002）。结论-本研究表明，在因 TIA/小卒中就诊的患者中，CT 血管造影在神经血管成像方面存在区域差异，这可能与就诊时的入院频率和同一问题的 90 天内再次入院有关。
