Journal article 1142 views 154 downloads
Referral pathways for patients with TIA avoiding hospital admission: a scoping review
,
Khalid Ali,
Jenna Bulger,
Gary A Ford,
Matthew Jones,
Chris Moore,
Alison Porter ,
Alan David Pryce,
Tom Quinn,
Anne Seagrove,
Helen Snooks ,
Shirley Whitman,
Nigel Rees
BMJ Open, Volume: 7, Issue: 2, Start page: e013443
Swansea University Authors:
Matthew Jones, Bridie Evans , Matthew Jones, Chris Moore, Alison Porter , Anne Seagrove, Helen Snooks
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DOI (Published version): 10.1136/bmjopen-2016-013443
Abstract
Objective: To identify the features and effects of a pathway for emergency assessment and referral of patients with suspected transient ischaemic attack (TIA) in order to avoid admission to hospital.Design: Scoping review.Data sources: PubMed, CINAHL Web of Science, Scopus.Study selection: Reports o...
| Published in: | BMJ Open |
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| ISSN: | 2044-6055 2044-6055 |
| Published: |
BMJ
2017
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| Online Access: |
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| URI: | https://cronfa.swan.ac.uk/Record/cronfa39030 |
| Abstract: |
Objective: To identify the features and effects of a pathway for emergency assessment and referral of patients with suspected transient ischaemic attack (TIA) in order to avoid admission to hospital.Design: Scoping review.Data sources: PubMed, CINAHL Web of Science, Scopus.Study selection: Reports of primary research on referral of patients with suspected TIA directly to specialist outpatient services.Data extraction: We screened studies for eligibility and extracted data from relevant studies. Data were analysed to describe setting, assessment and referral processes, treatment, implementation and outcomes.Results: 8 international studies were identified, mostly cohort designs. 4 pathways were used by family doctors and 3 pathways by emergency department physicians. No pathways used by paramedics were found. Referrals were made to specialist clinic either directly or via a 24-hour helpline. Practitioners identified TIA symptoms and risk of further events using a checklist including the ABCD2 tool or clinical assessment. Antiplatelet medication was often given, usually aspirin unless contraindicated. Some patients underwent tests before referral and discharge. 5 studies reported reduced incident of stroke at 90 days, from 6–10% predicted rate to 1.3–2.1% actual rate. Between 44% and 83% of suspected TIA cases in these studies were referred through the pathways.Conclusions: Research literature has focused on assessment and referral by family doctors and ED physicians to reduce hospitalisation of patients with TIA. No pathways for paramedical use were reported. We will use results of this scoping review to inform development of a paramedical referral pathway to be tested in a feasibility trial. |
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| College: |
Faculty of Medicine, Health and Life Sciences |
| Issue: |
2 |
| Start Page: |
e013443 |