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TIA指南(2).pdf

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ORIGINALARTICLE NationalStrokeAssociation RecommendationsforSystemsofCare forTransientIschemicAttack S.ClaiborneJohnston,MD,PhD,1,2GregoryW.Albers,MD,3PhilipB.Gorelick,MD,MPH,4 EthanCumbler,MD,5JeffreyKlingman,MD,6MichaelA.Ross,MD,7 MegBriggs,RN,BSN,8JeanCarlton,RN,BSC,9 EdwardP.Sloan,MD,MPH,10andUzmaVaince,MD11 Transientischemicattacks(TIAs)arecommonandportendahighshort-termriskofstroke.Evidence-based recommendationsfortheurgentevaluationandtreatmentofpatientswithTIAhavebeenpublished.However, implementationoftheserecommendationsreliablyandconsistentlywillrequirechangesinthesystemsofcare establishedforTIA.TheNationalStrokeAssociationconvenedamultidisciplinarypanelofexpertstodevelop recommendationsfortheessentialcomponentsofsystemsofcareathospitalstoimprovethequalityofcare providedtopatientswithTIA.Thepanelrecommendsthathospitalsestablishstandardizedprotocolstoassurerapid andcompleteevaluationandtreatmentforpatientswithTIA,withparticularattentiontourgencyandclose observationinpatientsathighriskofstroke. ANNNEUROL2011;000:000–000 orethan300,000transientischemicattacks(TIAs)ofhospitalbeds,EDs,andimaging.TheNationalStroke MarediagnosedeachyearinU.S.emergencydepart-Association(NSA)developedevidence-basedguidelinesfor ments(EDs).1Theshort-termriskofstrokeafterTIAisthemanagementofTIA,andtheAmericanHeartAssocia- substantial,with>9to10%ofpatientsreturningwithation(AHA)/AmericanStrokeAssociation(ASA)developed strokewithin90days,halfoccurringinthefirst2guidelinesfortheevaluationofTIA.5,6However,appropri- days.2,3Proveninterventionstoreducethisstrokeriskateimplementationoftheseguidelinesrequiresalteringsys- areavailablebutarefrequentlyunderutilized,particularlytemsofcareandnotjustthecareofindividualpatients. intheacuteperiodafteraTIA.TheNSAconvenedadiversegroupofexpertsto Optimizingpatientcareoftenrequiresalterationofreviewtheevidencesupportingdevelopmentofsystems thesystems,processes,andsettingsthroughwhichhealthcareofcareforTIAandtomakerecommendationsforhospi- isdelivered