Grant: Operating Grant

This study will validate a decision rule (or guideline) for physicians to use to determine which patients with transient ischemic attack, (TIA or mini-stroke) seen in emergency departments (ED), are at high risk of a stroke within the next 7 days. During a TIA, an individual experiences a sudden loss of neurological function with complete resolution over minutes to hours. TIAs are common; 20,000 patients are diagnosed with TIA in Canadian EDs annually. Most patients do well following a TIA; however, TIAs precede up to 20% of strokes. With a stroke, patients also suffer from a sudden loss of neurological function; however the neurological deficit lasts for more than 24 hours and may be permanent. Stroke is the leading cause of adult disability and the 3rd leading cause of death in Canada. Many strokes can be prevented if the cause of the TIA is identified. Defining the cause requires evaluation by a stroke specialist and a series of investigations. Unfortunately, with limited resources available, most centres do not have specialists assess all patients, nor do they perform all tests while patients are in the ED (i.e. CT scan, ultrasound of heart and neck arteries, electrocardiogram (ECG)). Knowing who is likely to have a stroke is critical in deciding the priority of testing. Our research team has developed the Canadian TIA Score, to determine the risk of an impending stroke. This score identifies patients at minimal, low, high and critical risk of a stroke within 7 days. This study will test the Canadian TIA Score in a new set of TIA patients to ensure it is safe and reliable. It is anticipated that minimal risk patients will follow-up with their family physician, low risk patients will see a specialist within one week, high risk patients will undergo testing in the ED with prompt follow-up and critical risk patients will see a specialist in the ED. We believe that the Canadian TIA Score will improve patient outcomes through the efficient use of existing resources.