194 TIA IMAGING: ARE WE FOLLOWING NICE 2020 GUIDELINES?. (18th November 2021)

• Record Type: Journal Article
• Authors: Egan, A; Kearns, J; Khalil, M; O'Connor, M
• Is Part Of: Age and ageing. Volume 50(2021)Supplement 3
• Publication Date: 2021-11-18
• Subjects: Aging -- Periodicals; Geriatrics -- Periodicals; 618.97
• DOI: 10.1093/ageing/afab219.194
• Languages: English
• ISSNs: 0002-0729

Abstract

Abstract: Background: CT brain imaging is customary in clinical practice after Transient Ischemic Attack (TIA). However, NICE (2020) guidelines recommend MRI brain with diffusion weighted and blood-sensitive sequences; to be completed on the same day as the assessment. The purpose is to detect the ischemic territory, haemorrhage, or other pathology. The aim of this audit was to assess the diagnostic radiology investigations performed on patients, over the age of sixty-five years, presenting with TIA to a university teaching hospital. Methods: We conducted a retrospective audit of all patients coded as TIA on the Hospital Inpatient-Enquiry (HIPE) system between July 2019 to July 2020. Data on brain imaging was accessed using the National Integrated Medical Imaging System (NIMIS) system. Hospital attendance records were accessed via the Emergency Department patient database. Data was analysed using Microsoft Excel. Results: Eighty patients had brain imaging performed (n = 38 CT brain only; n = 1 MRI only; n = 41 CT and MRI). Of these patients, only three had an MRI brain completed within twenty-four hours where thirty-nine patients had an MRI scans outside of twenty-four hours. Forty-one patients had both a CT and MRI brain imaging performed. The median time to MRI brain was three days and one and a half hours and the median time to CT brain was two hours and forty-nine minutes. Conclusion: This audit confirms duplication of TIA brain imaging and CT as the primary imaging tool for TIA which is not in keeping with best practice (NICE, 2020). This has implications for resources, radiation exposure and patient's length of stay. Development of dedicated ambulatory care pathways for TIA must incorporate rapid MRI access as the primary imaging modality.