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

Miriam Brazzelli; Kirsten Shuler; Zahid Quayyum; Donald Hadley; Keith Muir; Paul McNamee; Janet De Wilde; Martin Dennis; Peter Sandercock; Joanna M Wardlaw

doi:10.1136/bmjopen-2013-003359

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

Miriam Brazzelli, Kirsten Shuler, Zahid Quayyum, Donald Hadley, Keith Muir, Paul McNamee, Janet De Wilde, Martin Dennis, Peter Sandercock, Joanna M Wardlaw

Research output: Contribution to journal › Article › peer-review

22 Citations (Scopus)

10 Downloads (Pure)

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.

DESIGN: Cross-sectional survey.

SETTING: All UK clinical and imaging stroke-prevention services.

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.

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.

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.

Original language	English
Article number	3359
Journal	BMJ Open
Volume	3
Issue number	8
DOIs	https://doi.org/10.1136/bmjopen-2013-003359
Publication status	Published - 7 Aug 2013

Access to Document

10.1136/bmjopen-2013-003359

Clinical and imaging services for TIA and minor stroke: results of two surveys of practice across the UK
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/
Final published version, 723 KB

Cite this

@article{35a9c6fc7fcc49daa54b52b8b396cb2c,

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

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.DESIGN: Cross-sectional survey.SETTING: All UK clinical and imaging stroke-prevention services.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.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.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.",

author = "Miriam Brazzelli and Kirsten Shuler and Zahid Quayyum and Donald Hadley and Keith Muir and Paul McNamee and {De Wilde}, Janet and Martin Dennis and Peter Sandercock and Wardlaw, {Joanna M}",

year = "2013",

month = aug,

day = "7",

doi = "10.1136/bmjopen-2013-003359",

language = "English",

volume = "3",

journal = "BMJ Open",

issn = "2044-6055",

publisher = "BMJ Publishing Group",

number = "8",

}

TY - JOUR

T1 - Clinical and imaging services for TIA and minor stroke

T2 - results of two surveys of practice across the UK

AU - Brazzelli, Miriam

AU - Shuler, Kirsten

AU - Quayyum, Zahid

AU - Hadley, Donald

AU - Muir, Keith

AU - McNamee, Paul

AU - De Wilde, Janet

AU - Dennis, Martin

AU - Sandercock, Peter

AU - Wardlaw, Joanna M

PY - 2013/8/7

Y1 - 2013/8/7

N2 - 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.DESIGN: Cross-sectional survey.SETTING: All UK clinical and imaging stroke-prevention services.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.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.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.

AB - 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.DESIGN: Cross-sectional survey.SETTING: All UK clinical and imaging stroke-prevention services.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.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.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.

U2 - 10.1136/bmjopen-2013-003359

DO - 10.1136/bmjopen-2013-003359

M3 - Article

C2 - 23929917

SN - 2044-6055

VL - 3

JO - BMJ Open

JF - BMJ Open

IS - 8

M1 - 3359

ER -

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

Abstract

Access to Document

Fingerprint

Cite this