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Abstract Details

Evaluation of A Rapid Outpatient Stroke Clinic for TIA and Minor Stroke Patients in the Emergency Department
Cerebrovascular Disease and Interventional Neurology
P3 - Poster Session 3 (5:30 PM-6:30 PM)
3-054

To assess if a rapid access vascular neurology clinic is a feasible and safe means to evaluate patients with transient ischemic attack and minor stroke (TIAMS)(NIHSS < 5 with no debilitating deficits).

 
Current practice frequently prompts hospitalization for TIAMS in order to obtain comprehensive evaluation of stroke risk factors and mechanism; this is done to expedite workup and coordinate care. However, a subset of these patients who do not have debilitating deficits may not require inpatient hospitalization. We piloted a clinical protocol to assess the feasibility of conducting rapid stroke evaluations as an outpatient in low risk patients with TIAMS without disabling deficits.
The rapid access clinic was initiated at a single-site tertiary care facility for outpatient evaluation of TIAMS within 24 hours of emergency department (ED) evaluation. Patients were selected using a decision tool identifying presumed low-risk TIAMS seen in the ED. Criteria included medical (e.g. no disabling deficit, no thrombolytic agent given, negative CT for hemorrhagic stroke) as well as social criteria (e.g. patient ability to follow-up within 24 hours). Study population was evaluated for rates of noncompliance with post-ED follow-up and need for hospitalization from clinic. 90-day outcomes data was also recorded.
Between December 2016 and June 2018 a total of 162 TIAMS patients seen in the ED were recommended for the rapid access clinic utilizing the decision tool. Of these patients, 153 (94.4%) were evaluated within 24 hours of ED discharge. Only 2 patients (1.3%) who received outpatient evaluation required hospitalization; 101 (66%) had TIAMS on initial evaluation in clinic. 90 day outcomes data pending.
Our pilot data suggests that for a subset of patients, rapid outpatient evaluation may be a feasible and safe strategy for TIAMS management. Future work exploring such strategies may help improve TIAMS outcomes and reduce ED crowding and unnecessary hospital admissions.
Authors/Disclosures
Rachel P. Mehendale, MD (University of Chicago)
PRESENTER 		Dr. Mehendale has nothing to disclose.
Steven D. Shapiro, MD (Cooperman Barnabas Medical Center) Dr. Shapiro has nothing to disclose.
Bernard S. Chang, MD (Harvard Medical School) Dr. Chang has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Medical Association. Dr. Chang has received publishing royalties from a publication relating to health care.
Eliza C. Miller, MD (University of Pittsburgh) Dr. Miller has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for medical malpractice cases. The institution of Dr. Miller has received research support from National Institutes of Health. Dr. Miller has a non-compensated relationship as a member of ASA Advisory Council with American Heart Association/American Stroke Association that is relevant to AAN interests or activities.
Sara K. Rostanski, MD (NYU School of Medicine) Dr. Rostanski has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Individual law firms.
Benjamin R. Kummer, MD, FAAN Dr. Kummer has received personal compensation in the range of $0-$499 for serving as a Consultant for AlphaSights. Dr. Kummer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Syapse. Dr. Kummer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for NeuraHealth. Dr. Kummer has received personal compensation in the range of $0-$499 for serving as a Consultant for RONIN. Dr. Kummer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Guidepoint Global. Dr. Kummer has received personal compensation in the range of $0-$499 for serving as a Consultant for GLG. Dr. Kummer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Petauri Kinect. Dr. Kummer has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for 好色先生 . Dr. Kummer has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JMIR. Dr. Kummer has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Seminars in Neurology. Dr. Kummer has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Yoeli Gottlieb Etra LLP. Dr. Kummer has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for The Ashley Law Firm. Dr. Kummer has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Burns White Attorneys at Law. Dr. Kummer has stock in Syntrillo. The institution of Dr. Kummer has received research support from Icahn School of Medicine at Mount Sinai. Dr. Kummer has a non-compensated relationship as a Vice Chair Telehealth Subcommitte with 好色先生 that is relevant to AAN interests or activities. Dr. Kummer has a non-compensated relationship as a Vice Chair Quality Informatics Subcommittee with 好色先生 that is relevant to AAN interests or activities.
Joshua Z. Willey, MD, FAAN (Columbia University) Dr. Willey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbott. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Edwards Scientific. Dr. Willey has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for RECARDIO. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbott. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for BrainQ. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of the American College of Cardiology. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Uptodate. The institution of Dr. Willey has received research support from NIH. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving as a Review chapter author, MKSAP 16-20 with American College of Physicians.
Mitchell S. Elkind, MD, MS, FAAN Dr. Elkind has received personal compensation for serving as an employee of American Heart Association. Dr. Elkind has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Atria Academy.