Abstract Details

Title A Better Model for Evaluating Patients with TIA in Hospital Settings

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P02 - (-)

Poster/Presentation
Number 016

Objective

Background BACKGROUND: Hospitalization of patients with transient ischemic attack (TIA) provides opportunity for rapid evaluation and secondary prevention of stroke and other vascular events, but could be costly. Observation status with short-term (24-48 hours) hospitalization may be an alternative.

Design/Methods DESIGN/METHODS: A de-identified, retrospective chart review was performed in patients admitted to IPS and OBS in a 450-bed regional medical center in 2006 and 2010. Demographics, risk factors, ABCD2 scores (4.2 for OBS vs. 4.3 for IPS), diagnostic testing, medical/surgical treatment, hospital complications, outcomes (TIA, stroke, and MI), and 30/90-day readmission rates were compared. Length of stay (LOS)and hospitalization costs were compared also. Statistical methods included unpaired t-test, Wilcoxon Rank Sum, and Pearson's chi-square.

Results RESULTS: There were 347 IPS and 146 OBS patients. No significant differences were observed in demographic, stroke risk factors or medications (prior to, during or at discharge,) except that IPS group had a non statistically significant (NS)higher number of patients with a prior history of stroke and atrial fibrillation. CT, MRI, carotid ultrasound, and echocardiograms were performed similarly in both groups, except slightly more CTAs in IPS and MRAs in OBS (NS). During hospitalization, there was 1 stroke, 1 MI and 6 TIAs in IPS group and none in the OBS. Two deaths occurred in OBS group. Complications, vascular events,procedures and readmissions were similar. The mean LOS 1.28 days (SD 0.47days) in OBS vs 4.16 (SD 2 days) (p<.0001) in IPS group. The median total cost was $13,732 in OBS vs $19,428 in IPS group (p<.0001).

Conclusions CONCLUSIONS: Evaluating TIA patients in Observation setting can achieve a low rate of recurrent vascular events including stroke and readmissions for a substantially lower cost. This may prove to be a better model for future.

Authors/Disclosures
Bhuvaneswari Dandapani, MD (Health-First Medical Group) PRESENTER	No disclosure on file
	No disclosure on file
	No disclosure on file
James M. Gebel, MD (Akron General Medical Center)	No disclosure on file
	No disclosure on file
	No disclosure on file
Bernhard Hemmer, MD (Technische Universität München)	No disclosure on file
	No disclosure on file
	No disclosure on file

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