• Latha G Stead, M Fernanda Bellolio, Smitha Suravaram, Robert D Brown, Anjali Bhagra, Rachel M Gilmore, Eric T Boie, and Wyatt W Decker.
• Department of Emergency Medicine, Division of Research, Mayo Clinic College of Medicine, Generose G-410, 200 First Street SW, Rochester, MN 55905, USA. stead.latha@mayo.edu
• Neurocrit Care. 2009 Jan 1;10(2):204-8.

ObjectiveTo evaluate the feasibility of a protocol for evaluation of transient ischemic attack (TIA) in an Emergency Department Observation Unit (EDOU), and assess the risk of early stroke after such an evaluation.MethodsAll adult patients presenting to the Emergency Department (ED) with signs and symptoms consistent with TIA were prospectively enrolled in this observational study over a period of 3 years. Patients underwent a standardized TIA evaluation per protocol. Risk of subsequent stroke at 48 h, 1 week, 1 month, and 3 months was prospectively assessed.ResultsIn total, 418 patients were seen during the study period, and all were evaluated per the EDOU TIA protocol. The mean age was 73.1 (+/-13.3) years and 53.8% were males. Comorbidities included hypertension in 71.5%, diabetes mellitus in 20.1%, prior TIA in 19.6%, and prior ischemic stroke in 19.6% of the cohort. Brain CT, neurology consult, electrocardiogram, carotid ultrasound, and additional tests were performed, and education was given. A total of 30.4% of the patients were dismissed directly from the EDOU. The risk of stroke at 2 days was 0.96%, at 7 days 1.2%, at 30 days 1.9%, and 2.4% at 90 days.ConclusionAn Emergency Department Observation Unit Protocol for TIA is a feasible option for expedited evaluation of these patients.

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