70% of 'ministroke' patients discharged from ED with incomplete imaging never receive follow-up
Transient ischemic attacks, often called ministrokes, may be a warning sign of future health events. Yet many of these patients are not undergoing recommended follow-up imaging, one expert reported Tuesday at RSNA’s annual meeting.
A patient’s risk of stroke following TIA is about 7.6% after one year, jumping to 16.1% at year five. Although up to 80% of these cases can be avoided through early detection, imaging adherence rates remain low, explained Vincent Timpone, MD, an assistant professor of radiology at the University of Colorado.
“We found that compliance was improving but still suboptimal,” he added, commenting on recent trends. “About 20% of patients are discharged from the ED without any brain imaging and more than half are discharged without a complete neurovascular imaging workup.”
With this in mind, Timpone and colleagues set out to determine if patients may be completing their exams in outpatient settings. They assessed a sample of Medicare data covering 2017-2019, looking at whether individuals underwent a complete TIA workup. The latter includes MRI or CT brain imaging, CTA or MRA intracranial vascular examination and cervical vascular imaging via CTA, MRA or ultrasound.
Overall, the group looked at 6,346 patients admitted to the ED for TIA. Of that group, 59.9% (3,804 patients) completed their imaging in the emergency setting while 40.1% did not.
Of those who didn’t undergo ED imaging, 29.9% (761 patients) completed their follow-up in outpatient centers, doing so in an average of five days—longer than the recommended two days, Timpone noted. That means 70.1% were lost to follow-up with incomplete imaging work-up after their attack, he added.
Finally, Timpone and co-authors found Black patients, those 85 years or older and individuals treated at larger hospitals (400 beds or more) faced higher odds of not completing their follow-up imaging within 30 days of discharge.
Given TIA is a relatively common occurrence (about 300,000 cases in the U.S. each year) solutions to ensure patients are not overlooked may prevent many adverse outcomes.
“We need to investigate the causes for patient-level and hospital-level disparities in TIA imaging,” Timpone said during the session. “And perhaps most importantly, provide some solutions that can be implemented to address these disparities and provide more equitable access to imaging.”
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.