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Referral and triage of patients with transient ischemic attacks to an acute access clinic: risk stratification in an Australian setting

  1. Parker Magin1,*,
  2. Daniel Lasserson2,
  3. Mark Parsons3,4,
  4. Neil Spratt3,4,
  5. Malcolm Evans4,
  6. Michelle Russell4,
  7. Angela Royan4,
  8. Susan Goode1,
  9. Patrick McElduff5,
  10. Christopher Levi3,4

Article first published online: 12 MAR 2013

DOI: 10.1111/ijs.12014

Additional Information

How to Cite

Magin, P., Lasserson, D., Parsons, M., Spratt, N., Evans, M., Russell, M., Royan, A., Goode, S., McElduff, P. and Levi, C. (2013), Referral and triage of patients with transient ischemic attacks to an acute access clinic: risk stratification in an Australian setting. International Journal of Stroke. doi: 10.1111/ijs.12014

Author Information

  1. 1

    Discipline of General Practice, University of Newcastle, Callaghan, NSW, Australia

  2. 2

    Department of Primary Care Health Sciences, University of Oxford, Oxford, UK

  3. 3

    Discipline of Medicine, University of Newcastle, Callaghan, NSW, Australia

  4. 4

    Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia

  5. 5

    School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Callaghan, NSW, Australia

* Correspondence: Parker Magin*, Discipline of General Practice, University of Newcastle, Newbolds Building, University Drive, Callaghan, NSW 2308, Australia.
E-mail: parker.magin@newcastle.edu.au

  1. Conflict of interest: Authors Levi, Parsons, Spratt, Evans, Royan, and Russell have clinical roles at the John Hunter TIA/minor stroke acute access clinic.

Publication History

  1. Article first published online: 12 MAR 2013

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Keywords:

  • Transient ischemic attack;
  • prevention;
  • primary health care;
  • referral and consultation;
  • stroke;
  • triage

Background

Transient ischemic attacks and minor stroke entail considerable risk of completed stroke but this risk is reduced by prompt assessment and treatment. Risk can be stratified according to the ABCD2 prediction score. Current guidelines suggest specialist assessment and treatment within 24 h for high-risk event (ABCD2 score 4–7) and seven-days for low-risk event (ABCD2 score ≤ 3).

Aims

The study aims to establish paths to care and outcomes for patients referred by general practitioners and emergency departments to an Australian acute access transient ischemic attack service.

Methods

This is a prospective audit. Primary outcomes were time from event to referral, from referral to clinic appointment, and from event to appointment. ABCD2 score was calculated for each event. Time from event was modeled using Cox proportional hazards regression.

Results

There were 231 clinic attendees (general practitioner: 127; emergency department: 104). Mean time from event to referral was 9·2 days (SD 23·7, median 2), from referral to being seen in the clinic was 13·6 days (SD 19·0, median 7), and from event to being seen in the clinic was 17·2 days (SD 27·1, median 10). Of low-risk patients, 38·5% were seen within seven-days of event. Of high-risk patients, 36·7% were seen within one-day. ABCD2 score was not a significant predictor of any time interval from event to clinic attendance. There were no completed strokes prior to clinic attendance.

Conclusions

Times from event to clinic assessment were in excess of current recommendations and risk stratification was suboptimal, though short-term outcomes were good. Improvements in referral mechanisms may enhance risk-stratification and triage.

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