Post-emergency Management of Patients With Transient Ischemic Attack

A transient ischemic attack (TIA) is a momentary neurological dysfunction due to a brief cessation of blood flow to a region of the brain, resulting in typical signs of stroke (hemiplegia, aphasia, dysarthria), but whose clinical symptoms typically last less than an hour, with no visible lesion on imaging. This diagnosis remains difficult and is essentially based on the clinical judgment of the physician.

Because a TIA can be a "pre-alarm" for stroke in 20-30% of cases, it needs to be treated appropriately and as early as possible in the emergency department. Stroke rates after untreated TIA are 5% within 48 hours, 10% within one month and 20% within one year. This risk is calculated using the ABCD² score which is based on the patient's risk factors and the clinical manifestations of TIA. Patients with a score ≥ 3 should be hospitalized as soon as possible for a complete medical evaluation. However, this score has not been scientifically validated, and several specialists agree that all TIAs should be evaluated immediately. Preventing stroke is a major public health issue because it is a serious, disabling and sometimes fatal disease. Given the seriousness of the progression from TIA to stroke, the French National Authority for Health has issued a series of management recommendations. However, in practice, these guidelines remain complicated to follow and patients management may vary and be more or less effective.

Therefore, the aim of this study is to highlight the differences in how inpatients and outpatients are managed. Following these observations, solutions will be sought to make the care and management of these patients more efficient and more in line with recommendations.

Study Overview

• Status: Recruiting
• Conditions: Transient Ischemic Attack
• Intervention / Treatment: Behavioral: Satisfaction questionnaire; Other: Medical care questionnaire

• Study Type: Observational
• Enrollment (Estimated): 140

Contacts and Locations

• Study Contact: Name: Marilyne Grinand, PhD; Phone Number: (+33)432759392; Email: grinand.marilyne@ch-avignon.fr

Study Locations

• France
  • Provence-Alpes-Côte d'Azur
    • Avignon, Provence-Alpes-Côte d'Azur, France
      • Recruiting
      • Centre Hospitalier d'Avignon
      • Contact: Marilyne Grinand, PhD; Phone Number: (+33)432759392; Email: grinand.marilyne@ch-avignon.fr
      • Contact: Yohan Fouilhe, Medical Intern; Email: fouilhe.yohan@ch-avignon.fr
      • Principal Investigator: Yohan Fouilhe, Medical Intern
      • Sub-Investigator: Ludovic Sauvage, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Patients with a diagnosis of TIA in the emergency department

Description

Inclusion Criteria:

• Patient over 18 years old.
• Consultation in the emergency department.
• Suspected TIA diagnosed by emergency physician.
• Duration of TIA symptoms <1 hour.

Exclusion Criteria:

• Validation MRI performed prior to suspected TIA.
• Patient hospitalized for a condition other than TIA, including stroke.
• Patient referred to another hospital for further examination.
• Pregnant women.
• Patient unable to understand and answer a questionnaire.
• Patient under legal protection.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
TIA patients	Behavioral: Satisfaction questionnaire; Satisfaction questionnaire to assess how TIA patients feels about their medical care.; Other: Medical care questionnaire; Recording appointments and results of examinations and consultations in TIA management

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Assess time between arrival in the emergency department for suspected TIA patients and MRI.	Baseline

Secondary Outcome Measures

Outcome Measure	Time Frame
Time between arrival in the emergency department and MRI by departments.	Baseline
Time between arrival in the emergency department and MRI by ABCD² score.	Baseline
Percentage of patients with complete TIA management by departments.	Baseline
Hospitalization times according to care units	Baseline
Hospitalization times according to complete TIA management	Baseline
Percentage of patients with secondary event, according to complete TIA management	Baseline
Number of outpatients without complete TIA management one month after TIA.	At 1 month follow-up
Patient satisfaction with a short questionnaire	At 1 month follow-up

Collaborators and Investigators

• Sponsor: Centre Hospitalier Henri Duffaut - Avignon
• Investigators: Principal Investigator: Yohan Fouilhe, Medical Intern, Centre Hospitalier d'Avignon, Service des urgences

Study record dates

Study Major Dates

• Study Start (Actual): November 16, 2023
• Primary Completion (Estimated): May 16, 2024
• Study Completion (Estimated): June 16, 2024

Study Registration Dates

• First Submitted: November 17, 2023
• First Submitted That Met QC Criteria: December 6, 2023
• First Posted (Estimated): December 14, 2023

Study Record Updates

• Last Update Posted (Estimated): December 14, 2023
• Last Update Submitted That Met QC Criteria: December 6, 2023
• Last Verified: December 1, 2023

More Information

Terms related to this study

• Keywords: Emergency; Cerebral RMI; Guidelines compliance
• Additional Relevant MeSH Terms: Pathologic Processes; Cardiovascular Diseases; Vascular Diseases; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Disease Attributes; Brain Ischemia; Emergencies; Ischemia; Ischemic Attack, Transient
• Other Study ID Numbers: PEC AIT 84

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No