Background Outpatient management is safe and effective in preventing early recurrent stroke after TIA, but this approach may not be safe in patients with acute minor stroke.
Methods We prospectively studied outcomes of clinic and hospital-managed patients with TIA and minor stroke in a population based study from 2002–2007.
Results Of 845 patients with TIA and minor stroke referred, 587 (67%) were referred directly to outpatient clinics and 258 (30%) directly to inpatient services. Of 250 clinic-referred minor strokes (mean age=72.7 yrs), 237 (95%) were sent home the same day after investigation and treatment, of whom 16 (6.8%) were subsequently admitted to hospital within 30 days. The 150 patients (mean age=74.8 yrs) with minor ischaemic stroke referred to hospital (median length-of-stay=9 days) had a similar 30-day-readmission rate (6.3%; p=0.83) after initial discharge. The 30-day recurrent stroke risk was also similar in either setting (3.8% vs 5.3%, p=0.61). Rates of secondary prevention use were higher in clinic-managed vs hospital-managed patients for antiplatelets/anticoagulants (p<0.05) and lipid lowering (p<0.001) and remained high at 1-year follow-up. The mean (SD) 30-day hospital care cost per patient with minor ischaemic stroke was £8323 (13 133) for hospital-referred vs £743 (1794) for clinic-referred patients.
Conclusion Outpatient management of clinic-referred minor stroke is feasible and may be as safe as inpatient care. Costs of clinic care are lower.
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