Department of Radiology (V.M.T., P.S.T.), University of Colorado Hospital, Aurora.
Department of Neurology (S.N.P.), University of Colorado Hospital, Aurora.
Stroke. 2020 Aug;51(8):2563-2567. doi: 10.1161/STROKEAHA.120.029858. Epub 2020 Jul 10.
Multiple societal guidelines recommend urgent brain and neurovascular imaging in patients with transient ischemic attack (TIA) to identify and treat risk factors that may lead to future stroke. The purpose of this study was to evaluate whether national imaging utilization for workup of TIA complies with society guidelines.
Analysis utilized the Nationwide Emergency Department Sample. Primary analysis was performed on a 2017 cohort, and secondary trend analysis was performed on cohorts from 2006 to2017. Patients diagnosed and discharged from emergency departments with TIA were identified using and codes. Brain and neurovascular imaging obtained during the encounter was identified using Current Procedural Terminology codes. Demographics, health insurance, patient income, and hospital-type covariates were analyzed using a hierarchical multivariable logistic regression analysis to identify predictors of obtaining neurovascular imaging during an emergency department encounter.
In 2017, there were 167 999 patients evaluated and discharged from emergency departments with TIA. The percentage of patients receiving brain and neurovascular imaging was 78.5% and 43.2%, respectively. The most common imaging workup utilized was a solitary computed tomography-brain without any neurovascular imaging (30.9% of encounters). Decreased odds of obtaining neurovascular imaging was observed in Medicaid patients (odds ratio, 0.65 [95% CI, 0.58-0.74]), rural hospitals (odds ratio, 0.26 [95% CI, 0.17-0.41]), nontrauma centers (odds ratio, 0.40 [95% CI, 0.21-0.74]), and weekend encounters (odds ratio, 0.91 [95% CI, 0.85-0.96]). Trend analysis demonstrated a steady rise in brain and neurovascular imaging in 2006 from 34.9% and 6.8% of encounters, respectively, to 78.5% and 43.2% of encounters in 2017.
Compliance with imaging guidelines is improving; however, the majority of TIA patients discharged from the emergency department do not receive recommended neurovascular imaging during their encounter. Follow-up studies are needed to determine whether delayed or incomplete vascular screening increases the risk of future stroke.
多项社会指南建议对短暂性脑缺血发作（TIA）患者进行紧急脑部和神经血管成像，以识别和治疗可能导致未来中风的风险因素。本研究旨在评估全国 TIA 检查中影像学的应用是否符合社会指南。
分析利用了全国急诊部样本。主要分析是在 2017 年队列中进行的，二次趋势分析是在 2006 年至 2017 年的队列中进行的。使用 和 代码识别从急诊部诊断并出院的 TIA 患者。使用当前程序术语代码识别在就诊期间获得的脑部和神经血管成像。使用分层多变量逻辑回归分析分析人口统计学、健康保险、患者收入和医院类型协变量，以确定在急诊部就诊期间获得神经血管成像的预测因素。
2017 年，有 167999 名患者在急诊部接受评估并出院，其中有 78.5%和 43.2%的患者分别接受了脑部和神经血管成像。最常见的影像学检查是单独的 CT 脑部检查，没有任何神经血管成像（30.9%的就诊）。接受神经血管成像的可能性降低的患者包括医疗补助患者（优势比，0.65 [95%可信区间，0.58-0.74]）、农村医院（优势比，0.26 [95%可信区间，0.17-0.41]）、非创伤中心（优势比，0.40 [95%可信区间，0.21-0.74]）和周末就诊（优势比，0.91 [95%可信区间，0.85-0.96]）。趋势分析表明，2006 年，脑部和神经血管成像的比例分别从就诊的 34.9%和 6.8%稳步上升至 2017 年的 78.5%和 43.2%。
尽管与影像学指南的符合度在提高，但大多数从急诊部出院的 TIA 患者在就诊期间并未接受推荐的神经血管成像。需要进一步的研究来确定血管筛查的延迟或不完整是否会增加未来中风的风险。
