Have clinicians adopted the use of brain MRI for patients with TIA and minor stroke?

Seemant Chaturvedi, Susan Ofner, Fitsum Baye, Laura J. Myers, Mike Phipps, Jason J. Sico, Teresa Damush, Edward Miech, Mat Reeves, Jason Johanning, Linda Williams, Gregory Arling, Eric Cheng, Zhangsheng Yu, Dawn Bravata

Research output: Contribution to journalArticle

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Abstract

Background: Use of MRI with diffusion-weighted imaging (DWI) can identify infarcts in 30%-50% of patients with TIA. Previous guidelines have indicated that MRI-DWI is the preferred imaging modality for patients with TIA. We assessed the frequency of MRI utilization and predictors of MRI performance. Methods: A review of TIA and minor stroke patients evaluated at Veterans Affairs hospitals was conducted with regard to medical history, use of diagnostic imaging within 2 days of presentation, and in-hospital care variables. Chart abstraction was performed in a subset of hospitals to assess clinical variables not available in the administrative data. Results: A total of 7,889 patients with TIA/minor stroke were included. Overall, 6,694 patients (84.9%) had CT or MRI, with 3,396/6,694 (50.7%) having MRI. Variables that were associated with increased odds of CT performance were age >80 years, prior stroke, history of atrial fibrillation, heart failure, coronary artery disease, anxiety, and low hospital complexity, while blood pressure >140/90 mm Hg and high hospital complexity were associated with increased likelihood of MRI. Diplopia (87% had MRI, p = 0.03), neurologic consultation on the day of presentation (73% had MRI, p < 0.0001), and symptom duration of >6 hours (74% had MRI, p = 0.0009) were associated with MRI performance. Conclusions: Within a national health system, about 40% of patients with TIA/minor stroke had MRI performed within 2 days. Performance of MRI appeared to be influenced by several patient and facility-level variables, suggesting that there has been partial acceptance of the previous guideline that endorsed MRI for patients with TIA.

Original languageEnglish (US)
Pages (from-to)237-244
Number of pages8
JournalNeurology
Volume88
Issue number3
DOIs
StatePublished - Jan 17 2017

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Stroke
Brain
Diffusion Magnetic Resonance Imaging
Guidelines
Veterans Hospitals
Diplopia
Diagnostic Imaging
Atrial Fibrillation
Nervous System
Coronary Artery Disease
Referral and Consultation
Anxiety
Heart Failure
Blood Pressure
Health

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Have clinicians adopted the use of brain MRI for patients with TIA and minor stroke? / Chaturvedi, Seemant; Ofner, Susan; Baye, Fitsum; Myers, Laura J.; Phipps, Mike; Sico, Jason J.; Damush, Teresa; Miech, Edward; Reeves, Mat; Johanning, Jason; Williams, Linda; Arling, Gregory; Cheng, Eric; Yu, Zhangsheng; Bravata, Dawn.

In: Neurology, Vol. 88, No. 3, 17.01.2017, p. 237-244.

Research output: Contribution to journalArticle

Chaturvedi, S, Ofner, S, Baye, F, Myers, LJ, Phipps, M, Sico, JJ, Damush, T, Miech, E, Reeves, M, Johanning, J, Williams, L, Arling, G, Cheng, E, Yu, Z & Bravata, D 2017, 'Have clinicians adopted the use of brain MRI for patients with TIA and minor stroke?', Neurology, vol. 88, no. 3, pp. 237-244. https://doi.org/10.1212/WNL.0000000000003503
Chaturvedi S, Ofner S, Baye F, Myers LJ, Phipps M, Sico JJ et al. Have clinicians adopted the use of brain MRI for patients with TIA and minor stroke? Neurology. 2017 Jan 17;88(3):237-244. https://doi.org/10.1212/WNL.0000000000003503
Chaturvedi, Seemant ; Ofner, Susan ; Baye, Fitsum ; Myers, Laura J. ; Phipps, Mike ; Sico, Jason J. ; Damush, Teresa ; Miech, Edward ; Reeves, Mat ; Johanning, Jason ; Williams, Linda ; Arling, Gregory ; Cheng, Eric ; Yu, Zhangsheng ; Bravata, Dawn. / Have clinicians adopted the use of brain MRI for patients with TIA and minor stroke?. In: Neurology. 2017 ; Vol. 88, No. 3. pp. 237-244.
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abstract = "Background: Use of MRI with diffusion-weighted imaging (DWI) can identify infarcts in 30{\%}-50{\%} of patients with TIA. Previous guidelines have indicated that MRI-DWI is the preferred imaging modality for patients with TIA. We assessed the frequency of MRI utilization and predictors of MRI performance. Methods: A review of TIA and minor stroke patients evaluated at Veterans Affairs hospitals was conducted with regard to medical history, use of diagnostic imaging within 2 days of presentation, and in-hospital care variables. Chart abstraction was performed in a subset of hospitals to assess clinical variables not available in the administrative data. Results: A total of 7,889 patients with TIA/minor stroke were included. Overall, 6,694 patients (84.9{\%}) had CT or MRI, with 3,396/6,694 (50.7{\%}) having MRI. Variables that were associated with increased odds of CT performance were age >80 years, prior stroke, history of atrial fibrillation, heart failure, coronary artery disease, anxiety, and low hospital complexity, while blood pressure >140/90 mm Hg and high hospital complexity were associated with increased likelihood of MRI. Diplopia (87{\%} had MRI, p = 0.03), neurologic consultation on the day of presentation (73{\%} had MRI, p < 0.0001), and symptom duration of >6 hours (74{\%} had MRI, p = 0.0009) were associated with MRI performance. Conclusions: Within a national health system, about 40{\%} of patients with TIA/minor stroke had MRI performed within 2 days. Performance of MRI appeared to be influenced by several patient and facility-level variables, suggesting that there has been partial acceptance of the previous guideline that endorsed MRI for patients with TIA.",
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AU - Chaturvedi, Seemant

AU - Ofner, Susan

AU - Baye, Fitsum

AU - Myers, Laura J.

AU - Phipps, Mike

AU - Sico, Jason J.

AU - Damush, Teresa

AU - Miech, Edward

AU - Reeves, Mat

AU - Johanning, Jason

AU - Williams, Linda

AU - Arling, Gregory

AU - Cheng, Eric

AU - Yu, Zhangsheng

AU - Bravata, Dawn

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Y1 - 2017/1/17

N2 - Background: Use of MRI with diffusion-weighted imaging (DWI) can identify infarcts in 30%-50% of patients with TIA. Previous guidelines have indicated that MRI-DWI is the preferred imaging modality for patients with TIA. We assessed the frequency of MRI utilization and predictors of MRI performance. Methods: A review of TIA and minor stroke patients evaluated at Veterans Affairs hospitals was conducted with regard to medical history, use of diagnostic imaging within 2 days of presentation, and in-hospital care variables. Chart abstraction was performed in a subset of hospitals to assess clinical variables not available in the administrative data. Results: A total of 7,889 patients with TIA/minor stroke were included. Overall, 6,694 patients (84.9%) had CT or MRI, with 3,396/6,694 (50.7%) having MRI. Variables that were associated with increased odds of CT performance were age >80 years, prior stroke, history of atrial fibrillation, heart failure, coronary artery disease, anxiety, and low hospital complexity, while blood pressure >140/90 mm Hg and high hospital complexity were associated with increased likelihood of MRI. Diplopia (87% had MRI, p = 0.03), neurologic consultation on the day of presentation (73% had MRI, p < 0.0001), and symptom duration of >6 hours (74% had MRI, p = 0.0009) were associated with MRI performance. Conclusions: Within a national health system, about 40% of patients with TIA/minor stroke had MRI performed within 2 days. Performance of MRI appeared to be influenced by several patient and facility-level variables, suggesting that there has been partial acceptance of the previous guideline that endorsed MRI for patients with TIA.

AB - Background: Use of MRI with diffusion-weighted imaging (DWI) can identify infarcts in 30%-50% of patients with TIA. Previous guidelines have indicated that MRI-DWI is the preferred imaging modality for patients with TIA. We assessed the frequency of MRI utilization and predictors of MRI performance. Methods: A review of TIA and minor stroke patients evaluated at Veterans Affairs hospitals was conducted with regard to medical history, use of diagnostic imaging within 2 days of presentation, and in-hospital care variables. Chart abstraction was performed in a subset of hospitals to assess clinical variables not available in the administrative data. Results: A total of 7,889 patients with TIA/minor stroke were included. Overall, 6,694 patients (84.9%) had CT or MRI, with 3,396/6,694 (50.7%) having MRI. Variables that were associated with increased odds of CT performance were age >80 years, prior stroke, history of atrial fibrillation, heart failure, coronary artery disease, anxiety, and low hospital complexity, while blood pressure >140/90 mm Hg and high hospital complexity were associated with increased likelihood of MRI. Diplopia (87% had MRI, p = 0.03), neurologic consultation on the day of presentation (73% had MRI, p < 0.0001), and symptom duration of >6 hours (74% had MRI, p = 0.0009) were associated with MRI performance. Conclusions: Within a national health system, about 40% of patients with TIA/minor stroke had MRI performed within 2 days. Performance of MRI appeared to be influenced by several patient and facility-level variables, suggesting that there has been partial acceptance of the previous guideline that endorsed MRI for patients with TIA.

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