Audit of Transient Ischaemic Attack (TIA) inpatient management: a retrospective assessment

@#The aim of this retrospective study was to audit the management of transient ischaemic attack (TIA) patients admitted in 2012 compared to a previous audit (2009 to mid-2010). Data were obtained by reviewing the electronic clinical records of patients. Data on patient demographics, patient assessment and management according to TIA guidelines were collected. A total of 61 patients were admitted to hospital with primary diagnosis of TIA. One in four patients had an alternative diagnosis. TIA severity (ABCD2 score) was not calculated in 13% of the patients. Most patients had computed tomography (CT) brain imaging performed. Antiplatelet therapy was not adjusted in 10% of patients. Carotid doppler ultrasound was not considered in 20% of the patients. Most of the carotid dopplers were done within one week. Only 6.6% of the patients were referred for carotid endarterectomy. Blood pressure medications were not optimised in 57.4% of the patients. Only 27.9% were prescribed statin therapy. Not all patients had documented ECG findings or discussion regarding anticoagulation. There was a 32.8% 3-month readmission rate. In 2012 several aspects of TIA guideline management were not done appropriately compared to the previous audit. The areas of improvement identified in this assessment include optimising antiplatelet therapy and blood pressure management, as well as timely carotid ultrasound for anterior circulation TIA. Further education and reiteration of guideline-based TIA management is recommended. A follow-up audit of the service is warranted

Stroke Community Awareness among Public: A Cross Sectional Study

This study assessed the level of public awareness pertaining to risk factors,symptoms, treatment and source of information in relation to stroke and transient ischaemic attack. Stroke risk profile of the respondents was correlated with their level of knowledge. Using a validated pre-tested questionnaire, 112 respondents were recruited during two separate community events. Respondents completed the questionnaire and underwent health screening. The data were analysed using SPSS version 20. Overall knowledge was poor. Only 35% of the respondents had satisfactory knowledge of the warning signs (p= 0.94) and 29% had satisfactory knowledge on the risk factors (p=0.46). When analysed according to risk groups, 26%, 30% and 41% of respondents had satisfactory awareness in the low, intermediate and high risk group, respectively. None of the respondents knew about the availability of treatment of acute stroke in the emergency department or the importance of rehabilitation as part of stroke management. Public awareness on stroke risk factors, symptoms and management is poor.

The value of ABCD3-Ⅰ score in prediction of cerebral infarction after transient ischaemic attack / 中华内科杂志

Objective To assess the ability of ABCD3-Ⅰ score in evaluating the early risk of cerebral infarction after transient ischemic attack ( TIA ).Methods A total of 107 TIA patients were evaluated according to ABCD2,ABCD3 and ABCD3-Ⅰ criteria.The occurrences of cerebral infarction within 2 days and 7 days were observed.Results The AUCRoc of ABCD2,ABCD3 and ABCD3-Ⅰ were 0.61,0.66 and 0.71 in predicting the risk of cerebral infarction within 2 days,and were 0.62,0.68 and 0.74 in predicting within 7 days,respectively.Among 107 patients with TIA,13 evolved into cerebral infarction within 2 days,accounting for 12.1％,and 24 within 7 days,accounting for 22.4％.According to ABCD3-Ⅰ criteria,17 patients were of low risk scored 0-3 ; 54 patients were of medium risk scored 4-7 ; and 36 patients were of high risk scored 8-13.The different incidence of cerebral infarction after TIA was related to ABCD3-Ⅰ score:the higher the score was,the higher incidence was.Except for age factor,every score item of ABCD3-Ⅰ display obvious influence to the occurrence of cerebral infarction within 2 days and 7 days after TIA (P ＜ 0.05 ).Conclusion ABCD3-Ⅰ criteria could more effectively predict the occurrence of early risk of cerebral infarction after TIA,which could be used in regular clinical practice for assistance in TIA risk stratification and treatment.