This analysis seeks to describe temporal trends in transient ischemic attack (TIA) hospitalizations following Comprehensive Stroke Center (CSC) certification.

TIAs warrant rapid assessment by vascular neurologists to reduce risk of subsequent vascular events.  Trainees in neurology and emergency medicine need exposure to the diagnosis and management of this neurologic emergency.

We retrospectively identified patients with a discharge diagnosis of TIA between 2010-2017 at a tertiary stroke center. Patient demographics, clinical features, ABCD² score, discharging service, and length of stay(LOS) were collected. These characteristics were compared before and after CSC designation (designation May 2015 with a six-month washout period) using t-test, chi-square test, Wilcoxon signed-rank test, and Fisher’s Exact test at the 0.05 significance level.

During this seven year period, 778 TIA discharges were identified.  We observed a decline each year in the number of patients diagnosed with TIA with a slight increase in the last 2 years (155 discharges in 2010, nadir 59 discharges in 2015, 80 discharges in 2017).  Patient demographics, medical comorbidities, and ABCD² scores did not differ before and after CSC certification.  Following certification, patients with a final diagnosis of TIA were more likely to have received IV alteplase (7.1 vs 3.4%, p=0.05) and had a shorter LOS (median 2 vs. 1 days, p=0.04).  Patients were less likely to be discharged from a neurology service or be managed by a vascular neurologist after certification (55.9% vs. 68.0%, p=0.002).

Although TIA discharges decreased during our study interval, we observed shorter LOS and higher alteplase utilization following CSC designation.  As patients perceived to have higher stroke acuity are routed to CSCs, an inintended consequence may be that TIA patients are treated at other hospitals or on non-neurology services.  Lower TIA volumes at CSCs or on non-neurology services may also limit exposure to this critical neurologic diagnosis among neurology trainees.