Study Results

In 2007, the average stroke risk within 7 days of a TIA was estimated at 5.2%, with the risk ranging up to 12.8% in some studies[2]. Risk is highest within 48 hours of a TIA.

Substantial evidence was produced to show that active intervention for patients at high risk of stroke recurrence would reduce this risk. The EXPRESS study for example reported a highly significant reduction in the 90-day recurrent stroke rate in patients seen in the open access study clinic (4.4% vs 12.4%; p<0.0015) [3].

More recent work has suggested that this risk of early stroke after a TIA has approximately halved, which may reflect the benefits of aggressive secondary prevention pursued over the last decade [4]. Nevertheless, all suspected cerebrovascular events need to be investigated and treated urgently.

Emergency physicians should focus on the assessment of short term risk as this determines whether a patient needs immediate inpatient work-up or can be managed as an outpatient at an early access clinic.

By using a validated scoring system to evaluate risk, emergency physicians can identify and manage these patients effectively.

It is important to bear in mind the local availability of services. The UK National Sentinel Stroke Audits have shown that there is marked variation in service provision across the country. Data published in 2016 showed that only 73% of TIA clinics in the UK can see high risk TIA patients within 24 hours, 7 days a week, and can see low risk patients within a week [5]. This may limit the options available to emergency physicians for subsequent patient management.