Nationwide Patterns of Hospitalization after Transient Ischemic Attack

• Published in: Journal of stroke and cerebrovascular diseases Vol. 22; no. 7; pp. e142 - e145
• Main Authors: Kamel, Hooman, MD, Fahimi, Jahan, MD, MPH, Govindarajan, Prasanthi, MD, Navi, Babak B., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2013
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Cardiovascular; Emergency medicine; epidemiology; Female; Health Care Surveys; health policy; hospital stay; Hospitalization - statistics & numerical data; Humans; Ischemic Attack, Transient - diagnosis; Ischemic Attack, Transient - therapy; Male; Middle Aged; Neurology; organized stroke care; Risk Factors; transient ischemic attack; United States; United States; organized stroke care; epidemiology; transient ischemic attack; health policy; Emergency medicine; hospital stay
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2012.09.016

Background Little is known about nationwide patterns of hospitalization after transient ischemic attack (TIA). Methods In a nationally representative sample of Emergency Department (ED) visits included in the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 1997 through 2008, we estimated rates of hospitalization among patients with a primary ED diagnosis of TIA (International Classification of Diseases, 9th Revision (ICD-9), code 435). We used multiple logistic regression analysis to examine the association between hospitalization and demographic characteristics, geographic region, year of the visit, time of the visit, and markers of stroke risk. Results On the basis of 782 cases of TIA sampled by the NHAMCS, 57% (95% confidence interval [CI], 52%-61%) of patients with TIA nationwide were hospitalized. A higher proportion of patients was hospitalized in 2003 to 2008 (62%; 95% CI, 56%-68%) than in 1997 to 2002 (52%; 95% CI, 46%-58%; P  = .02). Compared with the US Northeast, patients were less likely to be hospitalized in the Midwest (odds ratio [OR], 0.5; 95% CI, .3-.9), the South (OR, 0.3; 95% CI, .2-.5), or the West (OR, 0.2; 95% CI, .1-.4). Compared with white patients, hospitalization was more likely among patients who were black (OR, 2.4; 95% CI, 1.3-4.5), Hispanic (OR, 3.8; 95% CI, 1.4-10.2), or of other races (OR, 3.5; 95% CI, 1.3-9.6). Patients with Medicaid were admitted less often than those with private insurance (OR, 0.3; 95% CI, .2-.8). Conclusions Nationwide patterns of hospitalization after TIA show significant regional and demographic variation. These results may provide a useful roadmap for efforts to improve systems of care for TIA across the country.