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Did Hospitalizations Helped Improve Outcome In Patients Who Presented With Transient Ischemic Attack? FREE TO VIEW

Qammar Abbas, MD; Viswanath Vasudevan, MD; Thi Thi Aye, MD; Praveen Jinnur, MD; Jose Contreras, MD; Farhad Arjomand, MD; Vijay Vanam, MD; Ameer Rasheed, MD
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The Brooklyn Hospital Center, Brooklyn, NY

Chest. 2013;144(4_MeetingAbstracts):556A. doi:10.1378/chest.1703128
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SESSION TITLE: Outcomes/Quality Control Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: It is a standard medical practice to hospitalize all patients who present to ER with TIA because TIA is a harbinger of stroke. Hospitalizations has many potential advantages. It facilitates expedited work up( ECHOCG, carotid Doppler, telemetry monitoring) Early institution of specific therapy such as antithrombotics in paroxysmal atrial fibrillation, LA/LV mural thrombus; early carotid artery revascularization in critical stenosis can preempt stroke. Timely recognition of stroke prompt institution of thrombolytics helps improve outcome. However, the current economic environment behooves us to provide high quality, safe and cost-effective care. The objective of the study is to identify the potential benefits of hospitalization.

METHODS: Design: Cross-sectional study: retrospective chart review of all patients admitted to the stroke unit. From 01/01/2010 to 2012 Inclusion: All patients who were hospitalized with a diagnosis of TIA. Exclusion: All patients who had focal neurological deficits on admission.

RESULTS: Outcome measures: Treatable causes identified and timely institution of specific therapy prevented stroke. Prompt recognition in CVA resulted in brain salvage therapy i.e TPA.; none Stroke in evolution was aborted with IV heparin.: none Telemonitoring identified paroxysmal Atrial fibrillation and anti-thrombotic Rx prevented cardioembolic CVA.: 1 patient who had sustained Afib on EKG. Carotid Doppler identified critical stenosis requiring urgent carotid artery revascularization procedure.two non critical carotid occlusion. No urgent revascularization. Medications at discharge: plavix ( 2), ASA(23), ASA+coumadin(1), ASA+Pradaxa (1)

CONCLUSIONS: Hospitalization did not emergently change patient management Hospitalization and expedited investigations changed the therapy in # patients. No patients developed completed stroke and or received thrombolytics. None received emergent IV heparin in stroke in evolution or as a bridge to coumadin therapy. It is safe to discharge TIA patients from ER with ASA/plavix. The TIA investigations may be done in an outpatient setting. It is prudent to hospitalize patients with underlying cardiac diseases, atrial fibrillation and carotid bruit.

CLINICAL IMPLICATIONS: A few number of patients benefits from hospitalization for 24 hours after Transient Ischemic Attacks. Out patient stroke clinic follow up and work up is may be more cost effective.

DISCLOSURE: The following authors have nothing to disclose: Qammar Abbas, Viswanath Vasudevan, Thi Thi Aye, Praveen Jinnur, Jose Contreras, Farhad Arjomand, Vijay Vanam, Ameer Rasheed

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