Protocol for Rapid Diagnosis of Mini-Strokes

An accelerated diagnostic protocol (ADP) has been developed to avoid the average three-day hospital stay for patients admitted for transient ischemic attack (TIA), commonly known as mini-strokes.

Researchers at Beaumont Hospital (Royal Oak, MI, USA) and Wayne State University (Detroit, MI, USA) conducted a study of 149 patients diagnosed with TIA. The patients were randomly assigned to the ADP group or to an inpatient hospital bed. All patients received the same four diagnostic tests (carotid imaging, echocardiogram, cardiac monitoring, and serial clinical evaluation), but those in the ADP group received those tests more rapidly. The median length of stay for the ADP group was 25 hours vs 61 hours for the admitted patients.

Although more ADP patients were found to have stroke during their initial visit (seven vs four), a comparable number developed a subsequent stroke (three vs. two) or other major clinical event (four each). In summary, using an accelerated diagnostic protocol in an emergency observation unit was more efficient, less costly, resulted in shorter hospitals stays, and had comparable clinical outcomes compared to traditional inpatient admission. The results were reported at the annual meeting of the Society for Academic Emergency Medicine in May 2006 in San Francisco (CA, USA).

"I think the protocol offers a win-win-win situation,” said lead author Dr. Michael A. Ross. "The patient has a shorter stay, the hospital keeps more beds open, and the doctor gets answers more quickly.”

One of the difficulties with TIA patients is that by the time they reach the emergency room, their symptoms may have disappeared. Over 10% of these patients will suffer a stroke within 90 days, with 64% of those strokes being disabling, and 5% will experience a major cardiac event.



Related Links:
Beaumont Hospital
Wayne State University