Clinical and imaging services for TIA and minor stroke: results of two surveys of practice across the UK

Brazzelli, M., Shuler, K., Quayyum, Z., Hadley, D., Muir, K. , McNamee, P., De Wilde, J., Dennis, M., Sandercock, P. and Wardlaw, J. M. (2013) Clinical and imaging services for TIA and minor stroke: results of two surveys of practice across the UK. BMJ Open, 3(8), e003359. (doi:10.1136/bmjopen-2013-003359)

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Publisher's URL: http://dx.doi.org/10.1136/bmjopen-2013-003359

Abstract

Objectives: Transient ischaemic attack (TIA) is a medical emergency requiring rapid access to effective, organised, stroke prevention. There are about 90 000 TIAs per year in the UK. We assessed whether stroke-prevention services in the UK meet Government targets.<p></p> Design: Cross-sectional survey.<p></p> Setting: All UK clinical and imaging stroke-prevention services.<p></p> Intervention: Electronic structured survey delivered over the web with automatic recording of responses into a database; reminders to non-respondents. The survey sought information on clinic frequency, staff, case-mix, details of brain and carotid artery imaging, medical and surgical treatments.<p></p> Results: 114 stroke clinical and 146 imaging surveys were completed (both response rates 45%). Stroke-prevention services were available in most (97%) centres but only 31% operated 7 days/week. Half of the clinic referrals were TIA mimics, most patients (75%) were prescribed secondary prevention prior to clinic referral, and nurses performed the medical assessment in 28% of centres. CT was the most common and fastest first-line investigation; MR, used in 51% of centres, mostly after CT, was delayed up to 2 weeks in 26%; 51% of centres omitted blood-sensitive (GRE/T2*) MR sequences. Carotid imaging was with ultrasound in 95% of centres and 59% performed endarterectomy within 1 week of deciding to operate.<p></p> Conclusions: Stroke-prevention services are widely available in the UK. Delays to MRI, its use in addition to CT while omitting key sequences to diagnose haemorrhage, limit the potential benefit of MRI in stroke prevention, but inflate costs. Assessing TIA mimics requires clinical neurology expertise yet nurses run 28% of clinics. Further improvements are still required for optimal stroke prevention.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Muir, Professor Keith and Hadley, Professor Donald and Quayyum, Dr Zahidul
Authors: Brazzelli, M., Shuler, K., Quayyum, Z., Hadley, D., Muir, K., McNamee, P., De Wilde, J., Dennis, M., Sandercock, P., and Wardlaw, J. M.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Health Economics and Health Technology Assessment
College of Medical Veterinary and Life Sciences > Institute of Neuroscience and Psychology
Journal Name:BMJ Open
Publisher:BMJ Publishing Group
ISSN:2044-6055
Copyright Holders:Copyright © 2013 The Authors
First Published:First published in BMJ Open 3(8):e003359
Publisher Policy:Reproduced under a Creative Commons License
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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
528741An Assessment of the Cost Effectiveness of Magnetic Resonance Including Diffusion-Weighted Brain Imaging in Patients with Transient Ischaemic Attack and Minor StrokeKeith MuirNational Institute for Health Research (NIHR)09/22/169RI NEUROSCIENCE & PSYCHOLOGY