Impact of Hospital Admission for Patients with Transient Ischemic Attack

Eric M. Cheng, Laura J. Myers, Stefanie Vassar, Dawn Bravata

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objectives: To determine the impact of admission among transient ischemic attack (TIA) patients in the emergency department (ED). Study Design: Retrospective cohort study using national Veterans Health Administration data (2008). Methods: We first analyzed whether admitted patients were discharged from the hospital with a diagnosis of TIA. We then analyzed whether admission was associated with a composite outcome (new stroke, new myocardial infarction, or death in the year after TIA) using multivariate logistic regression modeling with propensity score matching. Results: Among 3623 patients assigned a diagnosis of TIA in the ED, 2118 (58%) were admitted to the hospital or placed in observation compared with 1505 (42%) who were discharged from the ED. Among the 2118 patients who were admitted, 903 (43% of admitted group) were discharged from the hospital with a diagnosis of TIA, and 548 (26% of admitted group) were discharged with a diagnosis of stroke. Admitted patients were more likely than nonadmitted patients to receive processes of care (i.e., brain imaging, carotid imaging, echocardiography). In matched analyses using propensity scores, the 1-year composite outcome in the admitted group (15.3%) was not lower than the discharged group (13.3%, OR 1.17 [.94-1.46], P = .17). Conclusions: Less than half of patients admitted with a diagnosis of TIA retained that diagnosis at hospital discharge. Although admitted patients were more likely to receive diagnostic procedures, we did not identify improvements in outcomes among admitted patients; however, evaluating care for patients with TIA is limited by the reliability of secondary data analysis.

Original languageEnglish (US)
JournalJournal of Stroke and Cerebrovascular Diseases
DOIs
StateAccepted/In press - Jan 10 2017
Externally publishedYes

Fingerprint

Patient Admission
Transient Ischemic Attack
Hospital Emergency Service
Propensity Score
Stroke
Veterans Health
United States Department of Veterans Affairs
Neuroimaging
Echocardiography
Patient Care
Cohort Studies
Retrospective Studies
Logistic Models
Myocardial Infarction
Observation

Keywords

  • Diagnoses
  • Health policy and outcome research
  • Secondary prevention
  • Transient ischemic attack

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Impact of Hospital Admission for Patients with Transient Ischemic Attack. / Cheng, Eric M.; Myers, Laura J.; Vassar, Stefanie; Bravata, Dawn.

In: Journal of Stroke and Cerebrovascular Diseases, 10.01.2017.

Research output: Contribution to journalArticle

@article{f03e98de535d4a7c9b06971bf27a7f6a,
title = "Impact of Hospital Admission for Patients with Transient Ischemic Attack",
abstract = "Objectives: To determine the impact of admission among transient ischemic attack (TIA) patients in the emergency department (ED). Study Design: Retrospective cohort study using national Veterans Health Administration data (2008). Methods: We first analyzed whether admitted patients were discharged from the hospital with a diagnosis of TIA. We then analyzed whether admission was associated with a composite outcome (new stroke, new myocardial infarction, or death in the year after TIA) using multivariate logistic regression modeling with propensity score matching. Results: Among 3623 patients assigned a diagnosis of TIA in the ED, 2118 (58{\%}) were admitted to the hospital or placed in observation compared with 1505 (42{\%}) who were discharged from the ED. Among the 2118 patients who were admitted, 903 (43{\%} of admitted group) were discharged from the hospital with a diagnosis of TIA, and 548 (26{\%} of admitted group) were discharged with a diagnosis of stroke. Admitted patients were more likely than nonadmitted patients to receive processes of care (i.e., brain imaging, carotid imaging, echocardiography). In matched analyses using propensity scores, the 1-year composite outcome in the admitted group (15.3{\%}) was not lower than the discharged group (13.3{\%}, OR 1.17 [.94-1.46], P = .17). Conclusions: Less than half of patients admitted with a diagnosis of TIA retained that diagnosis at hospital discharge. Although admitted patients were more likely to receive diagnostic procedures, we did not identify improvements in outcomes among admitted patients; however, evaluating care for patients with TIA is limited by the reliability of secondary data analysis.",
keywords = "Diagnoses, Health policy and outcome research, Secondary prevention, Transient ischemic attack",
author = "Cheng, {Eric M.} and Myers, {Laura J.} and Stefanie Vassar and Dawn Bravata",
year = "2017",
month = "1",
day = "10",
doi = "10.1016/j.jstrokecerebrovasdis.2017.04.018",
language = "English (US)",
journal = "Journal of Stroke and Cerebrovascular Diseases",
issn = "1052-3057",
publisher = "W.B. Saunders Ltd",

}

TY - JOUR

T1 - Impact of Hospital Admission for Patients with Transient Ischemic Attack

AU - Cheng, Eric M.

AU - Myers, Laura J.

AU - Vassar, Stefanie

AU - Bravata, Dawn

PY - 2017/1/10

Y1 - 2017/1/10

N2 - Objectives: To determine the impact of admission among transient ischemic attack (TIA) patients in the emergency department (ED). Study Design: Retrospective cohort study using national Veterans Health Administration data (2008). Methods: We first analyzed whether admitted patients were discharged from the hospital with a diagnosis of TIA. We then analyzed whether admission was associated with a composite outcome (new stroke, new myocardial infarction, or death in the year after TIA) using multivariate logistic regression modeling with propensity score matching. Results: Among 3623 patients assigned a diagnosis of TIA in the ED, 2118 (58%) were admitted to the hospital or placed in observation compared with 1505 (42%) who were discharged from the ED. Among the 2118 patients who were admitted, 903 (43% of admitted group) were discharged from the hospital with a diagnosis of TIA, and 548 (26% of admitted group) were discharged with a diagnosis of stroke. Admitted patients were more likely than nonadmitted patients to receive processes of care (i.e., brain imaging, carotid imaging, echocardiography). In matched analyses using propensity scores, the 1-year composite outcome in the admitted group (15.3%) was not lower than the discharged group (13.3%, OR 1.17 [.94-1.46], P = .17). Conclusions: Less than half of patients admitted with a diagnosis of TIA retained that diagnosis at hospital discharge. Although admitted patients were more likely to receive diagnostic procedures, we did not identify improvements in outcomes among admitted patients; however, evaluating care for patients with TIA is limited by the reliability of secondary data analysis.

AB - Objectives: To determine the impact of admission among transient ischemic attack (TIA) patients in the emergency department (ED). Study Design: Retrospective cohort study using national Veterans Health Administration data (2008). Methods: We first analyzed whether admitted patients were discharged from the hospital with a diagnosis of TIA. We then analyzed whether admission was associated with a composite outcome (new stroke, new myocardial infarction, or death in the year after TIA) using multivariate logistic regression modeling with propensity score matching. Results: Among 3623 patients assigned a diagnosis of TIA in the ED, 2118 (58%) were admitted to the hospital or placed in observation compared with 1505 (42%) who were discharged from the ED. Among the 2118 patients who were admitted, 903 (43% of admitted group) were discharged from the hospital with a diagnosis of TIA, and 548 (26% of admitted group) were discharged with a diagnosis of stroke. Admitted patients were more likely than nonadmitted patients to receive processes of care (i.e., brain imaging, carotid imaging, echocardiography). In matched analyses using propensity scores, the 1-year composite outcome in the admitted group (15.3%) was not lower than the discharged group (13.3%, OR 1.17 [.94-1.46], P = .17). Conclusions: Less than half of patients admitted with a diagnosis of TIA retained that diagnosis at hospital discharge. Although admitted patients were more likely to receive diagnostic procedures, we did not identify improvements in outcomes among admitted patients; however, evaluating care for patients with TIA is limited by the reliability of secondary data analysis.

KW - Diagnoses

KW - Health policy and outcome research

KW - Secondary prevention

KW - Transient ischemic attack

UR - http://www.scopus.com/inward/record.url?scp=85019060894&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85019060894&partnerID=8YFLogxK

U2 - 10.1016/j.jstrokecerebrovasdis.2017.04.018

DO - 10.1016/j.jstrokecerebrovasdis.2017.04.018

M3 - Article

JO - Journal of Stroke and Cerebrovascular Diseases

JF - Journal of Stroke and Cerebrovascular Diseases

SN - 1052-3057

ER -