Tony Zhang

Tony is a Neurology Trainee at Auckland City Hospital and an alumni of Auckland Medical School. He has a side interest in medical education, having spent a year as a Medical Education Fellow at Waitemata District Health Board and is a current Honorary Lecturer with the Auckland School of Medicine. He is a coffee addict and a trail enthusiast. His favourite trail is the local Kepler track in Te Anau."

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Expediting Discharge For Patients Presenting To Hospital With Transient Ischemic Attacks​

Introduction
Transient Ischaemic Attacks (TIAs) are a medical emergency requiring urgent evaluation and prompt initiation of secondary prevention to reduce the risk of subsequent stroke. Neurovascular imaging is an essential component of TIA workup, but also places demand on acute radiology services. Delays in obtaining imaging translates to increased hospital bed occupancy and prolonged length of stay (LOS). First line neuroimaging often includes a CT angiogram (CTA) which can be completed concurrently with a CT head. It has the added benefit of being fast and accessible, without the need for a radiologist on site.  The aim of this study was to explore the impact of prompt neurovascular imaging with a CTA on mean LOS.
Methods
A retrospective analysis was conducted on 1034 patients presenting to Waitematā District Health Board with the primary discharge diagnosis of TIA over a three year period. All patients in the study population were considered to be surgical candidates for carotid revascularisation.
Results
455 patients received a CTA during the admission. Mean LOS was 25.3 hours for those who received their CTA within 6 hours of arrival to hospital (n=325) compared to 30.8 hours for patients who waited longer than 6 hours to have their CTA (n= 130) (p<0.001). Secondary analyses also identified that “presentation on a weekend” and “waiting for a stroke service consult” contributed to a longer mean LOS.
Conclusion:
For patients who are surgical candidates for carotid revascularisation, obtaining a CTA within 6 hours of hospital arrival reduced mean LOS  by 5.5 hours for patients presenting with TIAs.