Temporal Trends in the Use of Investigations After Stroke or Transient Ischemic Attack
Bibliographic Data
| ID | 9097545 |
|---|---|
| Authors | Vivian T Ng (University of Toronto, corresponding author), Ahmed M Bayoumi (0000-0002-7753-2828, University of Toronto, corresponding author), Jiming Fang (0000-0002-4526-0987, Institute for Clinical Evaluative Sciences), Kirsteen R Burton (University of Toronto), Melissa Stamplecoski (Institute for Clinical Evaluative Sciences), Jodi D Edwards (0000-0002-9275-4787, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre), Moira K Kapral (0000-0002-3444-9928, University of Toronto, corresponding author) |
| Year | 2016 |
| Volume | 54 |
| Issue | 5 |
| Pages | 430-434 |
| Publication date | 2016-05-01 |
| Open Access | No |
| Type | ARTICLE |
| Venue | Medical Care (JOURNAL) |
| Journal identifiers | ISSN: 0025-7079 • E-ISSN: 1537-1948 |
| Publisher | Ovid Technologies (Wolters Kluwer Health) (PUBLISHER) |
| DOI | 10.1097/mlr.0000000000000499 |
| PMID | 27075901 |
| OpenAlex | W2340897247 |
| Language | EN |
| Citations received | 1 |
| References cited | 13 |
BACKGROUND: Guidelines recommend that patients with stroke or transient ischemic attack (TIA) undergo neuroimaging and cardiac investigations to determine etiology and guide treatment. It is not known how the use of these investigations has changed over time and whether there have been associated changes in management. OBJECTIVES: To evaluate temporal trends in the use of brain and vascular imaging, echocardiography, and antithrombotic and surgical therapy after stroke or TIA. RESEARCH DESIGN: We analyzed 42,738 patients with stroke or TIA presenting to any of the 11 regional stroke centers in Ontario, Canada between 2003 and 2012 using the Ontario Stroke Registry database. The study period was divided into 1-year intervals and we used the Cochran-Armitage test to determine trends over time. RESULTS: Between 2003/2004 and 2011/2012, the proportion of patients undergoing brain imaging increased from 96% to 99%, as did the proportion receiving ≥3 brain scans (21%-39%), magnetic resonance imaging (13%-50%), vascular imaging (62%-88%), or echocardiography (52%-70%) (P<0.0001 for all comparisons). There was an increase in the proportion receiving any antithrombotic therapy (83%-91%, P<0.0001) but no change in use of anticoagulation (25% overall and 68% in subgroup with atrial fibrillation) or carotid revascularization (1.4%-1.5%, P=0.49). CONCLUSIONS: The use of investigations after stroke has increased over time without concomitant changes in medical or surgical management. Although initial neurovascular imaging is in accordance with practice guidelines, the use of multiple imaging procedures and routine echocardiography are of uncertain clinical effectiveness
Antithrombotic · Atrial fibrillation · Cardiology · Magnetic resonance imaging · Myocardial infarction · Neuroimaging · Neurovascular bundle · Radiology · Revascularization · Stroke (engine) · Acute Ischemic Stroke Management · Cerebrovascular and Carotid Artery Diseases · Internal Medicine · Medicine · Stroke Rehabilitation and Recovery · Surgery
| Citations per year | 0.1 |
|---|---|
| Citation span | 2016 - 2016 (1) |
| Highly cited | No |