Validation and safety of AmbuLatory care for transient ischemic attack from emergency department (VALID study)

Background: Transient Ischemic Attacks (TIAs) are a common reason for Emergency Department (ED) visits and represent a significant public health issue. Patients experiencing TIAs often face significant delays in undergoing various tests due to ED overcrowding and limited availability of neurologists. Emergency physicians (EPs) and neurologists have identified several criteria for allowing outpatient management. We conducted this study to assess the safety of this approach.

Methods: A reappointment pathway was established to oversee the management of TIAs following an ED visit. The primary objective was to evaluate the safety of this pathway by monitoring any events occurring between discharge from the ED and the neurology reappointment. We conducted a retrospective descriptive single-center study of patients who benefited from this pathway between September 2021 and September 2023. In the case of an event, we assessed sequalae using NIHSS and Modified Rankin Scale.

Results: 186 patients were included, with a mean age of 64 years. 53.7 % were women. The median ABCD² score was 3. The median time spent in the ED was 444 min. Eight patients experienced an event. The risk of post-TIA event was 2.7 % at 30 days, and 3.2 % at 90 days. None of the patients had sequala at the end of the follow-up. 12.9 % of MRI scans revealed recent established strokes.

Conclusion: Our study demonstrates the safety of a systematic reappointment pathway for patients presenting with TIAs in the ED. Future research should validate our results with larger cohorts and explore strategies to optimize outpatient management of patients.