Ambulatory TIA Clinic at CUH


Rapid Access Stroke Prevention,  Ambulatory TIA Clinic,  Fax:  021 4920355

 

Medical Professionals Information Guide 

A “one-stop” ambulatory TIA Clinic is available at Cork University Hospital. 

Patients with suspected TIA (transient ischemic attack) who

  1. Had focal neurological symptoms lasting <24hrs
  2. Have already made a complete recovery with no residual signs
  3. Have no red flags for immediate AMAU/ED referral
  4. Have an ABCD2 score of 4 or below 

are suitable for referral by their GP. Fax a RASP TIA Referral proforma and list of medicines to Fax 021-4920355. 

Patients with high risk clinical features or ABCD2 of above 4 should be referred to Acute Medical Assessment Unit or ED directly as before. 

Suitable patients will be contacted and given an 8am appointment usually within 24-48 hours of referral. 

Patients will have standardized investigations across the morning including blood tests, ECG, carotid imaging and brain imaging. They will be evaluated by the RASP (rapid-access stroke prevention) service and an urgent decision will be made regarding diagnosis, antithrombotic therapy and risk for recurrence. It is hoped the majority of these ambulatory patients can be discharged in the early afternoon without need for hospital bed admission. 

There will be two slots per day and the service will initially roll out on a pilot basis to GPs and their patients in Cork City and County. 

TIA is a medical emergency with a 10% risk of stroke in the first 14 days. As this service is to be provided with no additional resources and with carotid and brain imaging it is essential that only patients with suspected TIA are referred to the Rapid Access service. 

TIA usually presents as visual disturbance, aphasia, lateralized weakness or sensory distrurbance. In general, TIA is not a common cause of “collapse query cause”, loss of consciousness or isolated dizziness, and such patients are best referred through traditional routes. 

Referrals will be triaged and, for safety, unsuitable referrals may need to be diverted to ED or rejected (we will contact you to discuss in such cases).  

 

TIA-RASP Team

Dr Patrick Barry, Consultant AMAU Physician, TIA-RASP Co-director 

Dr Simon Cronin, Consultant Neurologist, TIA-RASP Co-director

 

Is Your Patient Suitable For RASP TIA Ambulatory Clinic? 

We accept patients with suspected TIA (transient ischemic attack) who

  1. Had recent focal neurological symptoms lasting <24hrs
  2. Have already made a complete recovery with no residual signs
  3. Have no red flags for immediate AMAU/ED referral
  4. Have an ABCD2 score of 4 or below

  

Red flags for immediate referral to AMAU or ED are

-       Any residual neurological symptoms

-       Any residual neurological signs

-       More than one episode in the last 4 weeks

-       Known tight carotid stenosis

-       Known atrial fibrillation but not on anti-coagulant

 

TIA RECURRENCE RISK STRATIFICATION (ABCD2 SCORING)

 

Age                  ≥ 60                  1

                        < 60                  0

 

BP        ≥ 140 / ≥ 90                   1

            < 140 / < 90                  0

 

Clinical symptoms/signs

        Hemiparesis                        2

        Only Speech disturbance     1

        All others                            0

 

Duration           > 60 mins          2

                        10 – 59 mins     1

                        < 10 mins          0

 

Diabetes           Yes                  1

                        No                    0

 

  

Patients with red flags or ABCD2 > 4 should be referred emergently to AMAU (8am to 5pm) or ED (5pm to 8am) 

Patients with loss of consciousness or collapse “query cause” are not suitable.

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