Abstract
Background Data on the risk of stroke after a TIA is mostly derived before the era of routine upfront CT angiography and improved pharmacotherapies. Differences between emergency department (ED) diagnosis of TIA and diagnosis in neurology outpatient clinic may alter these results.
Aims To assess the correlation between ED discharge diagnosis of TIA and neurology clinic diagnosis, and the risk of stroke after a TIA.
Methods Patients discharged from ED with a TIA diagnosis between 1stof July and 31st of October 2022 were included. Patients were followed-up at 30-days post-ED presentation by telephone, and medical records were reviewed at 90-days to ascertain neurologist diagnosis at clinic.
Results 70/128 (54.7%) patients were female, with a median age of 73. A neurologist agreed with the diagnosis of TIA in 21 of 108 patients reviewed in clinic (19.4%), with TIA a possible differential in another 17 (15.7%). 59 patients (54.6%) were felt unlikely to have had a TIA, and any new antithrombotic was ceased. 11 patients (10.2%) were re-diagnosed with having a minor stroke due to subtle persisting symptoms or MRI changes.
Four patients had a stroke within 90 days (3.1%). Two strokes occurred in patients with a neurologist TIA diagnosis, and one occurred in a patient with a diagnosis felt unlikely to be TIA. One patient who refused follow-up also had a stroke.
Conclusion The risk of stroke after discharge from ED with a TIA diagnosis appears stable despite improvements in imaging and pharmacotherapies. Further effort to improve diagnostic accuracy is needed.
