Early Hospitalization of Patients with TIA: A Prospective, Population-based Study

BackgroundThe German Stroke Society (GSS) recommends early hospitalization of patients with transient ischemic attack (TIA) regardless of ABCD2 score. This population-based study determined the rate of stroke during hospitalization and within 3 months after discharge, as well as the rates of mortality and readmission during the 3 months after discharge in patients with TIA.MethodsDuring a 36-month period (starting November 2007), 2200 consecutive patients (mean age, 70.6 ± 12.8 years; 49% women) with TIA from 15 hospitals in the Federal State of Schleswig-Holstein (1 of the 16 states in Germany) were prospectively evaluated during hospitalization and a follow-up time of 3 months after discharge. The primary outcomes were stroke during hospitalization and 3 months after discharge, as well as readmission and mortality at 3 months. Odds ratios (ORs) were calculated by the adjusted logistic regression analysis.ResultsOf 2200 patients (median time of admission, 6 hours from symptom onset), 24 patients (1.1%; 95% confidence interval [CI], 0.7%-1.5%) experienced a stroke during hospitalization (mean, 6 days), and of 1335 patients, 38 (2.8%; 95% CI, 2.1%-3.8%) experienced a stroke during the 3 months after discharge. Stroke during hospitalization was independently correlated with male sex (OR, 3.5) and acute brain infarction detected by brain imaging (OR, 2.6), whereas stroke within 3 months correlated with age greater than 65 years (OR, 3.0). The readmission rate (11.1%; 95% CI, 9.3%-12.7%) was increased in patients who had had previous stroke (OR, 1.7) but decreased in patients who were discharged with statin medication (OR, 0.6). The 3-month mortality (1.4%; 95% CI, 0.9%-1.9%) was independently correlated with unilateral weakness (OR, 2.6) and atrial fibrillation (AF) (OR, 2.6).ConclusionsThese findings may help clinicians to estimate the TIA prognosis in patients who were hospitalized early with TIA.