TIA mimics in a regional hospital emergency department.

Abstract

Background and Aims: Early diagnosis of transient ischemic attack (TIA) is crucial to allow commencement of secondary prevention and reduction of future stroke risk. This is challenging in emergency departments (EDs) as TIA presentations are heterogenous and brief. 20–40% of TIA referrals have a revised diagnosis of ‘TIA mimic’ following neurologist review. However, it is unknown if mimics occur with the same frequency in a regional setting. In order to optimize our TIA management pathway, we aimed to determine the frequency and types of mimics presenting to a large regional hospital ED. Methods: We conducted a 3-year retrospective cohort study of all suspected TIA presentations to the ED of Ballarat Health Services, a regional hospital in Victoria, Australia. Data were extracted from the medical record for all patients with an ICD-10 TIA code (G45.8, G45.9, G45.3). Documented diagnoses were reviewed by a Neurologist. Results: We identified 388 TIA presentations to our centre in the Victorian Emergency Minimum Dataset with 243 cases (62.6%) confirmed as true TIA or minor stroke. The 145 (37.4%) mimics included migraine (n¼ 19, 4.9%), transient global amnesia (n¼ 12, 3.1%), seizure (n¼ 8, 2.1%) and peripheral neuropathy (n¼ 7, 1.8%). Non-neurological mimics included delirium (n¼ 18, 4.6%), pre-syncope (n¼ 17, 3.5%) and hypoglycaemia (n¼ 4, 1.0%). Conclusions: Our results are similar to mimic frequency and type seen in metropolitan centres. Identifying more mimics at a point of referral may reduce the need of unwarranted investigation, medication and referrals. Our data will be used towards this aim