Hospital Admission After Transient Ischemic Attack

Unmasking Wolves in Sheep’s Clothing Carlos A. Molina, MD, PhD; Magdy M. Selim, PhD, MD. May 1, 2012.

Patients with TIA are at high risk of short-term stroke, myocardial infarction, and vascular death. Because stroke risk is reduced by immediate medical or surgical intervention, emergent evaluation and treatment is warranted. The Effect of urgent treatment of transient ischemic attack and minor stroke on early recurrent stroke (EXPRESS) and effectiveness of round-the-clock access (SOS-TIA) studies1 showed that urgent evaluation and initiation of preventive treatments such as antiplatelets, statins, anticoagulation, and carotid revascularization markedly reduce the risk of early stroke after a TIA or minor stroke. The ABCD2 score, based on clinical features and demographic data, has been shown to predict the short-term stroke risk after TIA and is being increasingly used to triage patients with TIA. However, its low interrater reliability, poor correlation with imaging findings, and its inability to identify patients who require in-hospital intervention preclude the use of the ABCD2 scores as a sole decision-making tool. In other words, the ABCD2 score represents field glasses that help shepherds to visualize a flock at a long distance in an attempt to discriminate sheep (low-risk TIAs) from wolves (high-risk TIAs). Read More