Background and Purpose:Multiple societal guidelines recommend urgent brain and neurovascular imaging in patients with transient ischemic attack (TIA) to identify and treat risk factors that may lead to future stroke. The purpose of this study was to evaluate whether national imaging utilization for workup of TIA complies with society guidelines.Methods:Analysis utilized the Nationwide Emergency Department Sample. Primary analysis was performed on a 2017 cohort, and secondary trend analysis was performed on cohorts from 2006 to2017. Patients diagnosed and discharged from emergency departments with TIA were identified using International Classification of Diseases, Ninth Revision and Tenth Revision codes. Brain and neurovascular imaging obtained during the encounter was identified using Current Procedural Terminology codes. Demographics, health insurance, patient income, and hospital-type covariates were analyzed using a hierarchical multivariable logistic regression analysis to identify predictors of obtaining neurovascular imaging during an emergency department encounter.Results:In 2017, there were 167 999 patients evaluated and discharged from emergency departments with TIA. The percentage of patients receiving brain and neurovascular imaging was 78.5% and 43.2%, respectively. The most common imaging workup utilized was a solitary computed tomography–brain without any neurovascular imaging (30.9% of encounters). Decreased odds of obtaining neurovascular imaging was observed in Medicaid patients (odds ratio, 0.65 [95% CI, 0.58–0.74]), rural hospitals (odds ratio, 0.26 [95% CI, 0.17–0.41]), nontrauma centers (odds ratio, 0.40 [95% CI, 0.21–0.74]), and weekend encounters (odds ratio, 0.91 [95% CI, 0.85–0.96]). Trend analysis demonstrated a steady rise in brain and neurovascular imaging in 2006 from 34.9% and 6.8% of encounters, respectively, to 78.5% and 43.2% of encounters in 2017.Conclusions:Compliance with imaging guidelines is improving; however, the majority of TIA patients discharged from the emergency department do not receive recommended neurovascular imaging during their encounter. Follow-up studies are needed to determine whether delayed or incomplete vascular screening increases the risk of future stroke.

中文翻译：

---

符合短暂性脑缺血发作检查的影像学指南：来自全国急诊科样本的证据。

背景与目的：多种社会指南建议对短暂性脑缺血发作（TIA）的患者进行紧急脑部和神经血管成像，以识别和治疗可能导致未来中风的危险因素。这项研究的目的是评估用于TIA检查的国家成像利用是否符合社会准则。方法：分析使用全国急诊科样本。在2017年队列中进行了主要分析，在2006年至2017年期间对队列进行了次要趋势分析。根据国际疾病分类，第九次修订和第十次修订，确定了由TIA急诊科诊断出院的患者代码。使用当前程序术语代码可以识别出在相遇期间获得的大脑和神经血管影像。使用分层多变量Logistic回归分析分析人口统计学，健康保险，患者收入和医院类型的协变量，以识别在急诊室遇到紧急情况时获得神经血管影像的预测因素。结果：2017年，有167999名患者被评估并从急诊中出院。与TIA相关的部门。接受脑部和神经血管成像的患者比例分别为78.5％和43.2％。使用的最常见的影像学检查是孤立的计算机断层扫描-脑部无任何神经血管影像学检查（占30.9％）。在医疗补助患者中，获得神经血管影像的几率降低了（赔率，0.65 [95％CI，0.58–0.74]），农村医院（赔率0.26 [95％CI，0.17-0.41]），非创伤中心（赔率0.40 [95％CI，0.21-0.74]）和周末聚会（赔率，0.91 [95％CI，0.85] –0.96]）。趋势分析表明，2006年脑部和神经血管影像的发生率稳步上升，分别从34.9％和6.8％上升到2017年的78.5％和43.2％。但是，从急诊科出院的大多数TIA患者在遇到期间都不会接受推荐的神经血管成像。需要进行后续研究以确定延迟或不完全的血管筛查是否会增加未来中风的风险。96]）。趋势分析表明，2006年脑部和神经血管影像的发生率稳步上升，分别从34.9％和6.8％上升到2017年的78.5％和43.2％。但是，从急诊科出院的大多数TIA患者在遇到期间都不会接受推荐的神经血管成像。需要进行后续研究以确定延迟或不完全的血管筛查是否会增加未来中风的风险。96]）。趋势分析表明，2006年脑部和神经血管影像的发生率稳步上升，分别从34.9％和6.8％上升到2017年的78.5％和43.2％。但是，从急诊科出院的大多数TIA患者在遇到期间都不会接受推荐的神经血管成像。需要进行后续研究以确定延迟或不完全的血管筛查是否会增加未来中风的风险。从急诊科出院的大多数TIA患者在遇到期间未接受推荐的神经血管影像检查。需要进行后续研究以确定延迟或不完全的血管筛查是否会增加未来中风的风险。从急诊科出院的大多数TIA患者在遇到期间未接受推荐的神经血管影像检查。需要进行后续研究以确定延迟或不完全的血管筛查是否会增加未来中风的风险。