Introduction and Objectives: After a transient ischemic attack, there is a 90 day increased risk of stroke that can be predicted by ABCD2 score. A TIA clinic for low risk (ABCD2 score <4) was established at Kaiser Permanente. We hypothesized that patients seen in this clinic would have the same 90 day re-admission rate as those evaluated inpatient.
Methods: At Kaiser Permanente LAMC, a TIA clinic was established in November 2, 2010. TIAs were triaged by a Neurologist who calculated the ABCD2 score. Patients were referred to the TIA clinic with a score <4 and evaluated inpatient if score ≥4. Patient data was abstracted for all patients with a TIA clinic referral placed between November 2, 2010 and February 28, 2013 (182 charts) and 148 were included in the analysis. Patients were excluded if the ABCD2 score could not be calculated or referral was inappropriate. The ICD-9 code was used to abstract patients with TIA for the same time period (145 charts) and 58 patients were included. Non-Kaiser members and patients for which a Neurologist was unable to calculate ABCD2 score were excluded. All charts were reviewed for 90 day re-admission. Data was analyzed using chi-squared testing of independence and Fischer’s exact test to assess for a difference in all cause and stroke only 90 day re-admission rates for patients with ABCD2 scores <4 and ≥4 who were evaluated in TIA clinic vs. inpatient.
Results: No significant difference in the rate of re-admission for all cause with ABCD2 score ≥4 in TIA clinic (20%) vs inpatient (28.2%) was found (p= 0.379), but a significant rate of re-admission for stroke was found with TIA clinic (0%) vs inpatient (10.3%) (p= 0.042). A significant rate of re-admission for all cause with ABCD2 score <4 in TIA clinic (14.4%) vs inpatient (5.6%) was not found (p = 0.462) and re-admission for stroke in TIA clinic (2.9%) vs inpatient (0%) was not found (p=1.00).
Limitations: Non-members were excluded due to inability for follow up, and there may have been variability in documentation of pertinent information for calculating ABCD2 scores.
Conclusion: TIA clinic evaluation of low risk patients (ABCD2 score <4) does not increase the risk for 90 day re-admission for all causes or stroke only.