1. Benefits of Urgent Evaluation and Treatment for TIA and Minor Stroke Summary and Comment by Kristi L. Koenig, MD, FACEP Published in Journal Watch Emergency Medicine March 6, 2009Journal Watch Emergency Medicine Early neurological assessment and treatment is cost-effective and prevents long- term disability. CopyrightCopyright © 2009. Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society

2. Covering Luengo-Fernandez R et al. Effect of urgent treatment for transient ischaemic attack and minor stroke on disability and hospital costs (EXPRESS study): A prospective population-based sequential comparison. Lancet Neurol 2009 Mar; 8:235. CopyrightCopyright © 2009. Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society

3. Background Do patients with transient ischemic attack (TIA) or minor stroke need urgent specialty evaluation and treatment? As part of the two-phase, prospective, population-based EXPRESS (Early use of eXisting PREventive Strategies for Stroke) study, British researchers evaluated the effect of early assessment and treatment on hospital admission, costs, and disability. In the first phase, 310 patients were referred to a specialty clinic by their primary care physicians within several days of the acute event, and treatment recommendations were faxed to the primary care physicians (median time to treatment, 19 days); in the second phase, 281 patients were sent directly to the specialty clinic and received treatment the same day. CopyrightCopyright © 2009. Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society

4. The Research The rate of hospital admission for recurrent stroke within 90 days was significantly lower in the second phase than in the first phase (2% vs. 8%). The number of hospital bed-days for stroke and other cardiovascular conditions declined from 1365 in the first phase to 427 in the second phase, yielding an average hospital cost savings per patient of £624 (about US$900). The incidence of fatal or disabling stroke at 6-month follow-up was significantly lower in the second phase than in the first phase (0.3% vs. 5.1%). The authors conclude that urgent assessment and treatment of patients with minor stroke or TIA reduces disability and healthcare costs. CopyrightCopyright © 2009. Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society

5. Comment Patients with TIA should be considered to have unstable angina of the brain and to require urgent attention. Prompt neurological evaluation and treatment not only benefits individual patients but also results in decreased overall healthcare costs, both in the short term and in the long term (by reducing severe stroke disability). CopyrightCopyright © 2009. Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society

6. About Journal Watch Journal Watch helps physicians and allied heath professionals save time and stay informed by providing brief, clearly written, clinically focused perspectives on the medical developments that affect practice. Journal Watch is an independent, trustworthy source, from the publishers of the New England Journal of Medicine. These slides were derived from Journal Watch Emergency Medicine.Journal Watch Emergency Medicine The best way to stay informed with Journal Watch, is through our alerts. To sign up, visit the My Alerts page.My Alerts page CopyrightCopyright © 2009. Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society