A Comparison of the Evaluation and Treatment of Transient Ischemic Attack in a Comprehensive Stroke Center and Four Acute Stroke Ready Hospitals

Objective: This study was designed to investigate the difference in diagnostic stroke evaluation (DSE) and secondary stroke prevention (SSP) measures at acute stroke ready hospitals (ASRHs) compared to a comprehensive stroke center (CSC). Background: The 90-day stroke risk following TIA may approach 15–20%. It is well established that expedited DSE and initiation of necessary SSP following TIA significantly reduces stroke risk. In contrast to patients undergoing acute stroke interventions, TIA patients are less commonly transferred to CSCs. Design/Methods: ICD 10 codes were used to identify all TIA patients admitted between Jan 2016 and Mar 2018 at four ASRHs and one CSC. Patients whose diagnosis was unclear or whose evaluation was limited by goals of care were excluded. DSE and SSP practices were assessed using variables derived from AHA evidence-based, best practice guidelines. The percentage of completed DSE and SSP elements was calculated for each hospital. Results: 301 patients were analyzed in total (ASRH1=16, ASRH2=26, ASRH3=28, ASRH4=134, CSC=97). The CSC had more complete DSE (85%) and SSP (82%) than each ASRH. There was a significant difference between the CSC and the ASRHs in the percentage of patients admitted. (Percentage admitted CSC vs ASRH1 vs ASRH2 vs ASRH3 vs ASRH4: 85% vs 26% vs 43% vs 38% vs 62%). There was significant variability between ASRHs in the percentage of completed DSE elements (ASRH1=61%, ASRH2=65%, ASRH3=73%, ASRH4=82%, p Conclusions: Our study found a more complete DSE and more robust initiation of SSP following TIA at the CSC. Our findings merit further investigation. If confirmed on a larger scale, there are considerable healthcare implications for optimizing cost-effective DSE and SSP in non-CSCs in order to reduce recurrent stroke risk following TIA. Disclosure: Dr. Jarnot has nothing to disclose. Dr. Zhang has nothing to disclose. Dr. Salari has nothing to disclose. Dr. Stinson has nothing to disclose. Dr. Alkuwaiti has nothing to disclose. Dr. Engkjer has nothing to disclose. Dr. Heyer has nothing to disclose. Dr. Reichert has nothing to disclose. Dr. Anderson has nothing to disclose. Dr. Streib has nothing to disclose.