26. : Transient ischaemic attack diagnosis at first assessment of minor stroke

Transient ischaemic attack (TIA) is a heterogeneous emergency department (ED) diagnosis, often including patients with minor stroke. This study aimed to determine the proportion of patients with ischaemic stroke admitted to hospital who had an ED diagnosis of TIA. We aimed to determine their clinical characteristics, the reasons for the revision of the diagnosis to stroke, and the effect of early investigation on secondary prevention treatments used. In this retrospective study we reviewed charts of consecutive patients with a discharge to home diagnosis of ischaemic stroke requiring admission of up to 7 days between 2009 and 2012. We extracted demographics, risk factors, medications, ED and neurologist history and physical signs, radiology results, and secondary prevention treatments. There were 264 patients, 202 (76.5%) with an ED diagnosis of stroke, 37 (14.0%) with a diagnosis of TIA and 25 (9.5%) with non-cerebrovascular diagnoses in ED. ED physicians reported residual neurological symptoms or signs in 49% of our patients diagnosed with TIA. MRI with diffusion-weighted imaging was performed in 211 (80%). The diagnosis was revised from TIA to stroke based on neurologist assessment, identification of infarction on neuroimaging or a combination of both. In 31% of patients, early investigation discovered modifiable risk factors for recurrent stroke, including new inpatient atrial fibrillation, carotid artery stenosis >50% and patent foramen ovale. Residual symptoms or signs at presentation are common in patients given a diagnosis of TIA in the ED, and are indicative of established ischaemic stroke rather than TIA in a high proportion of patients. Admission and early investigation of patients with minor stroke can expedite detection of specific stroke aetiologies with major secondary prevention implications.