• Am J Emerg Med · Apr 2020

    Observational Study

    Initiation of the ABCD3-I algorithm for expediated evaluation of transient ischemic attack patients in an emergency department.

    • Robert T Dahlquist, Joseph M Young, Karina Reyner, Ali Farzad, Richard B Moleno, Gautami Gandham, Amy F Ho, and Hao Wang.
    • Department of Emergency Medicine, Baylor University Medical Center, 3500 Gaston Ave., Dallas, TX 75246, United States of America.
    • Am J Emerg Med. 2020 Apr 1; 38 (4): 741-745.

    BackgroundThe use of ABCD3-I score for Transient ischemic attack (TIA) evaluation has not been widely investigated in the ED. We aim to determine the performance and cost-effectiveness of an ABCD3-I based pathway for expedited evaluation of TIA patients in the ED.MethodsWe conducted a single-center, pre- and post-intervention study among ED patients with possible TIA. Accrual occurred for seven months before (Oct. 2016-April 2017) and after (Oct. 2017-April 2018) implementing the ABCD3-I algorithm with a five-month wash-in period (May-Sept. 2017). Total ED length of stay (LOS), admissions to the hospital, healthcare cost, and 90-day ED returns with subsequent stroke were analyzed and compared.ResultsPre-implementation and post-implementation cohorts included 143 and 118 patients respectively. A total of 132 (92%) patients were admitted to the hospital in the pre-implementation cohort in comparison to 28 (24%) patients admitted in the post-implementation cohort (p < 0.001) with similar 90-day post-discharge stroke occurrence (2 in pre-implementation versus 1 in post-implementation groups, p > 0.05). The mean ABCD2 scores were 4.5 (1.4) in pre- and 4.1 (1.3) in post-implementation cohorts (p = 0.01). The mean ABCD3-I scores were 4.5 (1.8) in post-implementation cohorts. Total ED LOS was 310 min (201, 420) in pre- and 275 min (222, 342) in post-implementation cohorts (p > 0.05). Utilization of the ABCD3-I algorithm saved an average of over 40% of total healthcare cost per patient in the post-implementation cohort.ConclusionsThe initiation of an ABCD3-I based pathway for TIA evaluation in the ED significantly decreased hospital admissions and cost with similar 90-day neurological outcomes.Copyright © 2019 Elsevier Inc. All rights reserved.

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