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Title: Emergency management of TIA in regional Australia.
Author: Wrigley, Scott
Sahathevan, Ramesh
Sanders, Lauren
Hair, Casey
Issue Date: 2018
Conference Name: Ballarat Health Services 2018 Annual Research Symposium: research partnerships for population, people and patients; celebrating our research partnerships with the community in the Grampians region
Conference Date: November 29th
Conference Place: Ballarat
Abstract: Background Untreated, Transient Ischemic Attack (TIA) bears a 10-17% subsequent 90-day stroke risk. Models of care that expedite investigation and management can reduce this risk to 1-3%. Regional Australians are 19% more likely to suffer a stroke in their lifetime, yet no evaluation of regional TIA care has been undertaken and the impact of relative resource limitations is unknown. Objectives/Aims The aim of this study was to assess management and outcomes of TIA patients in a regional Australian health service. Method We performed a retrospective cohort study of patients presenting to Ballarat Health Services emergency department with TIA, between January 2015 and December 2017. Presentations were identified from the Victorian Emergency Minimum Dataset using ICD-10-AM codes (G45.9, G45.8, G45.3). Patient files were sourced on the Ballarat Health Services BOSSNET database and demographic, investigation and management data were collected. Outcomes of interest were subsequent 90-day stroke, 90-day re-presentation and additional clinic appointments. Results There were 480 suspected TIA presentations revised to three diagnostic groups on specialist review: Stroke/TIA 243 (age 70.6±12.4 years); TIA Mimic 145 (65.6±16.2); ?TIA 92 (67.8±15.2). The overall subsequent 90-day stroke rate was 1.88% (9/480). In those with specialist confirmed TIA or stroke, this rate was 3.29% (8/243). The 90-day representation rate was 9.85% with significant association for smoking and carotid disease when excluding TIA mimics. Only carotid disease was independently associated with 90-day representation on multivariate analysis (OR 5.36, 95%CI 1.78-16.14, p=0.003). Of the 272 cases reviewed in TIA clinic, 121 (44.5%) needed an additional appointment. Review by a neurologist prior to discharge was associated with fewer additional TIA clinic appointments needed to review further investigations. Implications/Outcomes for Planned Research Project Our data highlight the importance of accurate diagnosis and early appropriate commencement of secondary prevention in minimising stroke risk. Addressing resource limitations and defining the roles of emergency physicians, general practitioners and available specialists is essential to optimise regional preventative stroke care. Final Thoughts Further work must be done to improve the flow of patients through TIA Clinic and outline challenges facing general practitioners in delivering TIA care.  
Internal ID Number: 01274
Type: Conference
Appears in Collections:Research Output

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