Ischemic Stroke After Emergency Department Discharge for Symptoms of Transient Neurological Attack.

Content Provider	Europe PMC
Author	Parikh, Neal S. Merkler, Alexander E. Kummer, Benjamin R. Kamel, Hooman
Copyright Year	2018
Abstract	Background and Purpose: The significance of transient neurological attack (TNA) symptoms is unclear. We sought to determine the risk of ischemic stroke after discharge from the emergency department (ED) with a diagnosis consistent with symptoms of TNA. Methods: Using administrative claims data, we identified patients discharged from EDs in New York between 2006 and 2012 with a primary discharge diagnosis of a TNA symptom, defined as altered mental status, generalized weakness, and sensory changes. The primary outcome was ischemic stroke. We used Kaplan-Meier survival statistics to calculate cumulative rates, and Cox regression to compare stroke risk after TNA versus after transient ischemic attack (TIA; positive control) or renal colic (negative control) while adjusting for demographics and vascular risk factors. Results: Of 499 369 patients diagnosed with a TNA symptom and discharged from the ED, 7756 were hospitalized for ischemic stroke over a period of 4.7 (±1.9) years. At 90 days, the cumulative stroke rate was 0.29% (95% confidence interval [CI]: 0.28%-0.31%) after TNA symptoms versus 2.08% (95% CI: 1.89%-2.28%) after TIA and 0.03% (95% CI: 0.02%-0.04%) after renal colic. The hazard ratio (HR) of stroke was higher after TNA than after renal colic (HR: 2.13; 95% CI: 1.90-2.40) but significantly lower than after TIA (HR: 0.47; 95% CI: 0.44-0.50). Compared to TIA, TNA was less strongly associated with stroke among patients under 60 years of age compared to those over 60. Conclusions: Patients discharged from the ED with TNA symptoms faced a higher risk of ischemic stroke than patients with renal colic, but the magnitude of stroke risk was low, particularly compared to TIA.
Related Links	https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC6022908&blobtype=pdf
ISSN	19418744
Volume Number	8
DOI	10.1177/1941874417750996
PubMed Central reference number	PMC6022908
Issue Number	3
PubMed reference number	29977444
Journal	The Neurohospitalist [Neurohospitalist]
e-ISSN	19418752
Language	English
Publisher	SAGE Publications
Publisher Date	2018-02-18
Publisher Place	Sage CA: Los Angeles, CA
Access Restriction	Open
Rights License	© The Author(s) 2018
Subject Keyword	stroke cerebrovascular disorders transient ischemic attack
Content Type	Text
Resource Type	Article
Subject	Neurology (clinical)