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{
    "pk": 11018,
    "title": "Implementation of a Rapid, Protocol-based TIA Management Pathway",
    "subtitle": null,
    "abstract": "Introduction:\n Our goal was to assess whether use of a standardized clinical protocol improves efficiency for patients who present to the emergency department (ED) with symptoms of transient ischemic attack (TIA).\nMethods:\n We performed a structured, retrospective, cohort study at a large, urban, tertiary care academic center. In July 2012 this hospital implemented a standardized protocol for patients with suspected TIA. The protocol selected high-risk patients for admission and low/intermediate-risk patients to an ED observation unit for workup. Recommended workup included brain imaging, vascular imaging, cardiac monitoring, and observation. Patients were included if clinical providers determined the need for workup for TIA. We included consecutive patients presenting during a six-month period prior to protocol implementation, and those presenting between 6-12 months after implementation. Outcomes included ED length of stay (LOS), hospital LOS, use of neuroimaging, and 90-day risk of stroke or TIA.\nResults:\n From 01/2012 to 06/2012, 130 patients were evaluated for TIA symptoms in the ED, and from 01/2013 to 06/2013, 150 patients. The final diagnosis was TIA or stroke in 45% before vs. 41% after (p=0.18). Following the intervention, the inpatient admission rate decreased from 62% to 24% (p<0.001), median ED LOS decreased by 1.2 hours (5.7 to 4.9 hours, p=0.027), and median total hospital LOS from 29.4 hours to 23.1 hours (p=0.019). The proportion of patients receiving head computed tomography (CT) went from 68% to 58% (p=0.087); brain magnetic resonance (MR) imaging from 83% to 88%, (p=0.44) neck CT angiography from 32% to 22% (p=0.039); and neck MR angiography from 61% to 72% (p=0.046). Ninety-day stroke or recurrent TIA among those with final diagnosis of TIA was 3% for both periods.\nConclusion:\n Implementation of a TIA protocol significantly reduced ED LOS and total hospital LOS.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "transient ischemic attack"
        },
        {
            "word": "emergencies"
        },
        {
            "word": "stroke"
        },
        {
            "word": "Length of Stay"
        }
    ],
    "section": "Neuroscience",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/0cq365s9",
    "frozenauthors": [
        {
            "first_name": "Susann",
            "middle_name": "J.",
            "last_name": "Jarhult",
            "name_suffix": "",
            "institution": "Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts\nUppsala University, Department of Medical Sciences, Uppsala, Sweden",
            "department": "None"
        },
        {
            "first_name": "Melissa",
            "middle_name": "L.",
            "last_name": "Howell",
            "name_suffix": "",
            "institution": "Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts",
            "department": "None"
        },
        {
            "first_name": "Isabelle",
            "middle_name": "",
            "last_name": "Barnaure-Nachbar",
            "name_suffix": "",
            "institution": "Geneva University Hospitals, Department of Radiology, Geneva, Switzerland",
            "department": "None"
        },
        {
            "first_name": "Yuchiao",
            "middle_name": "",
            "last_name": "Chang",
            "name_suffix": "",
            "institution": "Massachusetts General Hospital, Department of Medicine, Boston, Massachusetts",
            "department": "None"
        },
        {
            "first_name": "Benjamin",
            "middle_name": "A.",
            "last_name": "White",
            "name_suffix": "",
            "institution": "Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts",
            "department": "None"
        },
        {
            "first_name": "Mary",
            "middle_name": "",
            "last_name": "Amatangelo",
            "name_suffix": "",
            "institution": "Brigham and Women’s Hospital, Department of Neurology, Boston, Massachusetts",
            "department": "None"
        },
        {
            "first_name": "David",
            "middle_name": "F.",
            "last_name": "Brown",
            "name_suffix": "",
            "institution": "Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts",
            "department": "None"
        },
        {
            "first_name": "Aneesh",
            "middle_name": "B.",
            "last_name": "Singhal",
            "name_suffix": "",
            "institution": "Massachusetts General Hospital, Department of Neurology, Boston, Massachusetts",
            "department": "None"
        },
        {
            "first_name": "Lee",
            "middle_name": "H.",
            "last_name": "Schwamm",
            "name_suffix": "",
            "institution": "Massachusetts General Hospital, Department of Neurology, Boston, Massachusetts",
            "department": "None"
        },
        {
            "first_name": "Scott",
            "middle_name": "B.",
            "last_name": "Silverman",
            "name_suffix": "",
            "institution": "Massachusetts General Hospital, Department of Neurology, Boston, Massachusetts",
            "department": "None"
        },
        {
            "first_name": "Joshua",
            "middle_name": "",
            "last_name": "Goldstein",
            "name_suffix": "",
            "institution": "Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts",
            "department": "None"
        }
    ],
    "date_submitted": "2017-06-16T17:57:55Z",
    "date_accepted": "2017-06-16T17:57:55Z",
    "date_published": "2018-02-08T18:51:13Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/11018/galley/5937/download/"
        }
    ]
}