Adult Patients With Suspected Transient Ischemic Attack in the Emergency Department

Publication Date: June 1, 2016
Last Updated: March 14, 2022

Recommendations

In adult patients with suspected TIA, do not rely on current existing risk stratification instruments (eg, age, blood pressure, clinical features, duration of TIA and presence of diabetes [ABCD2] score) to identify TIA patients who can be safely discharged from the ED. (B)
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  1. The safety of delaying neuroimaging from the initial ED workup is unknown. If noncontrast brain MRI is not readily available, it is reasonable for physicians to obtain a noncontrast head CT as part of the initial TIA workup to identify TIA mimics (eg, intracranial hemorrhage, mass lesion). However, noncontrast head CT should not be used to identify patients at high short-term risk for stroke.
  2. When feasible, physicians should obtain MRI with diffusion-weighted imaging (DWI) to identify patients at high short-term risk for stroke.
  3. When feasible, physicians should obtain cervical vascular imaging (eg, carotid ultrasonography, CTA, or MRA) to identify patients at high short-term risk for stroke.
(C)
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In adult patients with suspected TIA, carotid ultrasonography may be used to exclude severe carotid stenosis because it has accuracy similar to that of MRA or CTA. (C)
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In adult patients with suspected TIA without high-risk conditions, a rapid ED-based diagnostic protocol may be used to evaluate patients at short-term risk for stroke. High-risk conditions include abnormal initial head CT result (if obtained), suspected embolic source (presence of atrial fibrillation, cardiomyopathy, or valvulopathy), known carotid stenosis, previous large stroke, and crescendo TIA. (B)
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Recommendation Grading

Overview

Title

Adult Patients With Suspected Transient Ischemic Attack in the Emergency Department

Authoring Organization

Publication Month/Year

June 1, 2016

Last Updated Month/Year

August 1, 2023

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

This clinical policy from the American College of Emergency Physicians addresses key issues for adults presenting to the emergency department with suspected transient ischemic attack

Target Patient Population

Patients with suspected TIA

Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Emergency care

Intended Users

Paramedic emt, nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Management

Diseases/Conditions (MeSH)

D020521 - Stroke, D002546 - Ischemic Attack, Transient, D004635 - Emergency Medicine

Keywords

Transient Ischemic Attack, emergency medicine

Source Citation

Ann Emerg Med. 2016;68:354-370

Methodology

Number of Source Documents
72
Literature Search Start Date
January 1, 2000
Literature Search End Date
March 18, 2015