Short-term outcomes of Chinese transient ischaemic attack patients in an Emergency department in Hong Kong: Result of management with an agreed protocol with neurologists

Introduction: Emergency department management of transient ischaemic attack varies from admission for all to outpatient referral. We studied the short-term outcomes of transient ischaemic attack managed with an agreed protocol. Predictors of stroke can be different for Asians and non-Asians. ABCD(2) as initial triage of transient ischaemic attack is debatable. The predictive ability of ABCD(2) score was studied as well. Methods: This was a prospective observational study with consecutive subject recruitment in Emergency department. All transient ischaemic attacks were admitted, hard and e-records of Emergency department, transient ischaemic attack clinic, Medical and Neurosurgical department and general follow-ups in Hospital Authority hospitals were studied up to 1 year. Stroke-day was measured from symptom-onset to time-of-stroke. Results: In 18-month period, 124 patients were recruited. The median onset-to-door time was 3.5 h. All computed tomography brain positive findings, except one subdural haematoma, were ischaemic in origin. Six strokes, all disabling, recurred within 90 days, three on day 1-3, two died in 6 months. The stroke risks at 2, 7, 90 days and 1 year were 1.61%, 3.23%, 4.84% and 4.84%, respectively. No significant trend was observed in stroke risk across ABCD(2) scores (p = 0.783) with area under the curve of 0.537 (95% confidence interval = 0.380-0.694; p = 0.762). The short-term stroke risk was associated with atrial fibrillation (p = 0.002). The median Emergency Medicine ward length of stay was 1.33 days. Conclusion: In our Emergency department-based management, the short-term stroke risk of transient ischaemic attack is low, and the predictivity of ABCD(2) score in risk stratification cannot be validated. Stroke recurrences were associated with atrial fibrillation. A low ABCD(2) could be falsely reassuring. As half of the strokes recurred very early, we recommend admission in the hyperacute phase.