Great work on this but I disagree with your comments on disposition. ACEP clinical policy regarding dispo states "Level B: In adult patients with suspected TIA, do not rely on current existing risk-stratification instruments (eg, ABCD2 score) to identify TIA patients who can be safely discharged from the emergency department."
I dont necessarily agree with that statement for all cases, but I take that as the standard of care as defined by our professional society. As such, I dont think it is medicolegally defensible to discharge TIA patients.
I think this is a good point and is applicable to many providers. The risk assessment tools we currently have are far from perfect. However, there are some situations in which discharge is reasonable. For example, you are able to get their full workup and a neuro consult either in the ED or in an expedited fashion, and the patient is low risk by your clinical assessment. Also, some providers may be hundreds of miles away from an MRI, consultants, and the other components of the workup. We try not to be absolute in our recommendations because there is so much variation depending on where you practice.
Video of the neurological exam that determines full resolution ought be useful. Useful for all neurological emergencies Headache Migraine Epilepsy Meningitis
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Krishna P. - February 3, 2018 2:16 PM
Great work on this but I disagree with your comments on disposition. ACEP clinical policy regarding dispo states "Level B: In adult patients with suspected TIA, do not rely on current existing risk-stratification instruments (eg, ABCD2 score) to identify TIA patients who can be safely discharged from the emergency department."
I dont necessarily agree with that statement for all cases, but I take that as the standard of care as defined by our professional society. As such, I dont think it is medicolegally defensible to discharge TIA patients.
Jess Mason - February 3, 2018 3:06 PM
I think this is a good point and is applicable to many providers. The risk assessment tools we currently have are far from perfect. However, there are some situations in which discharge is reasonable. For example, you are able to get their full workup and a neuro consult either in the ED or in an expedited fashion, and the patient is low risk by your clinical assessment. Also, some providers may be hundreds of miles away from an MRI, consultants, and the other components of the workup. We try not to be absolute in our recommendations because there is so much variation depending on where you practice.
Ian L. - February 10, 2018 4:31 PM
Video of the neurological exam that determines full resolution ought be useful.
Useful for all neurological emergencies
Headache Migraine Epilepsy Meningitis