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Regional Variation in Transient Ischemic Attack and Minor Stroke in Alberta Emergency Departments

AB-CP-TIA and Stroke Variation

Alberta (ED)

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%; P<0.0001)   compared with Edmonton (6.7%) and nonmajor urban region (5.7%) and higher   proportion of discharged patients (83%; P<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%; P=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.

Authors: Michelle Leong, Jillian M. Stang, Natasha McGuire, Eddy Lang, Shelagh B. Coutts, Catherine Patocka

Catherine Patocka -

Preliminary data gathering/ baseline

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