A transient ischaemic attack clinic with round-the-clock access (SOS-TIA): feasibility and effects - 16/08/11

Doi : 10.1016/S1474-4422(07)70248-X

Philippa C Lavallée, MD ^a, Elena Meseguer, MD ^a, Halim Abboud, MD ^a, Lucie Cabrejo, MD ^a, Jean-Marc Olivot, MD ^a, Olivier Simon, MD ^a, Mikael Mazighi, MD ^a, Chantal Nifle, MD ^a, Philippe Niclot, MD ^a, Bertrand Lapergue, MD ^a, Isabelle F Klein, MD ^b, Eric Brochet, MD ^c, Philippe Gabriel Steg, MD ^c, Guy Lesèche, MD ^d, Julien Labreuche, BS ^a, Pierre-Jean Touboul, MD ^a, Pierre Amarenco, MD ^a,^⁎
^a Department of Neurology and Stroke Centre, Bichat–Claude Bernard University Hospital, Denis Diderot University and Medical School—Paris VII, Assistance Publique-Hôpitaux de Paris, Paris, France
^b Neuroradiology Unit, Department of Radiology, Bichat–Claude Bernard University Hospital, Denis Diderot University and Medical School—Paris VII, Assistance Publique-Hôpitaux de Paris, Paris, France
^c Department of Cardiology, Bichat–Claude Bernard University Hospital, Denis Diderot University and Medical School—Paris VII, Assistance Publique-Hôpitaux de Paris, Paris, France
^d Department of Vascular Surgery, Bichat–Claude Bernard University Hospital, Denis Diderot University and Medical School—Paris VII, Assistance Publique-Hôpitaux de Paris, Paris, France

^*Correspondence to: Pierre Amarenco, Department of Neurology and Stroke Centre, Bichat–Claude Bernard University Hospital, Denis Diderot University and Medical School—Paris VII, 46 Rue Henri Huchard, 75018 Paris, France

Summary

Background

Diagnosis and treatment of cerebral and retinal transient ischaemic attacks (TIAs) are often delayed by the lack of immediate access to a dedicated TIA clinic. We evaluated the effects of rapid assessment of patients with TIA on clinical decision making, length of hospital stay, and subsequent stroke rates.

Methods

We set up SOS-TIA, a hospital clinic with 24-h access. Patients were admitted if they had sudden retinal or cerebral focal symptoms judged to relate to ischaemia and if they made a total recovery. Assessment, which included neurological, arterial, and cardiac imaging, was within 4 h of admission. A leaflet about TIA with a toll-free telephone number for SOS-TIA was sent to 15000 family doctors, cardiologists, neurologists, and ophthalmologists in Paris and its administrative region. Endpoints were stroke within 90 days, and stroke, myocardial infarction, and vascular death within 1 year.

Findings

Between January, 2003, and December, 2005, we admitted 1085 patients with suspected TIA; 574 (53%) were seen within 24 h of symptom onset. 701 (65%) patients had confirmed TIA or minor stroke, and 144 (13%) had possible TIA. 108 (17%) of the 643 patients with confirmed TIA had brain tissue damage. Median duration of symptoms was 15 min (IQR 5–75 min). Of the patients with confirmed or possible TIA, all started a stroke prevention programme, 43 (5%) had urgent carotid revascularisation, and 44 (5%) were treated for atrial fibrillation with anticoagulants. 808 (74%) of all patients seen were sent home on the same day. The 90-day stroke rate was 1·24% (95% CI 0·72–2·12), whereas the rate predicted from ABCD² scores was 5·96%.

Interpretation

Use of TIA clinics with 24-h access and immediate initiation of preventive treatment might greatly reduce length of hospital stay and risk of stroke compared with expected risk.

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Vol 6 - N° 11

P. 953-960 - novembre 2007 Retour au numéro

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Fast assessment of stroke and transient ischaemic attack to prevent early recurrence (FASTER): a randomised controlled pilot trial
James Kennedy, Michael D Hill, Karla J Ryckborst, Michael Eliasziw, Andrew M Demchuk, Alastair M Buchan, for the FASTER Investigators ‡

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A transient ischaemic attack clinic with round-the-clock access (SOS-TIA): feasibility and effects - 16/08/11

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