Inpatient versus Outpatient Management of TIA or Minor Stroke: Clinical Outcome

Abstract

Background—The management of patients with acute transient ischemic attack (TIA) or minor stroke is
highly variable. Whether hospitalization of such patients significantly improves short-term clinical outcome
is unknown. We assessed the short-term clinical outcome associated with inpatient versus outpatient management of patients with TIA or minor stroke.
Methods—We evaluated a consecutive series of patients with acute TIA or minor ischemic stroke (NIH
Stroke Scale score ≤ 3) presenting to a single emergency department (ED). We randomized patients to
either hospital-based or outpatient-based management. All patients underwent interview and examination
7–10 days following the index event.
Results—This study included 100 patients, 41 with TIA and 59 with minor stroke. Nineteen (46%) of the
TIA patients and 29 (49%) of the minor stroke patients randomized to hospital management, and the
remaining 22 TIA patients and 30 minor stroke patients randomized to outpatient-based management. In
the patients with a minor stroke, neurologic worsening occurred in 6 out of 29 (21%) in the inpatient arm
compared with 3 out of 30 (10%) in the outpatient arm (p = 0.3). In none of these cases was acute interventional therapy or need for urgent admission considered medically appropriate. In the patients with a TIA,
recurrence of a TIA occurred in 2 out of 19 (11%) in the inpatient arm compared with 2 out of 22 (9%) in
the outpatient arm (p = 1). None of the patients with a TIA randomized to the inpatient arm experienced a
stroke compared with 1 out of 22 in the outpatient arm (p = 1). There were no deaths in either group.
Conclusion—Routine hospitalization of all patients with TIA or minor ischemic stroke may not positively affect short-term clinical outcome.