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22. European Stroke Conference 711 Acute cerebrovascular events (ACE): TIA and minor strokes Age Difference in the referral pattern to TIA clinic Y.K. Kee1, S. Mahmood2, E. Lawrence3 Croydon University Hospital, London, UNITED KINGDOM1, Croydon University Hospital, London, UNITED KINGDOM2, Croydon University Hospital, London, UNITED KINGDOM3 Background: To determine whether there are age differences in the pathway from first symptoms to when a patient is seen at a transient ischaemic attack (TIA) clinic. Methods: Data were collected prospectively over a 14-month period from consecutive attendances in an open access TIA clinic. The reported duration from (1) first symptoms was assessed to the fol-lowing, (2) presentation to the general practitioner (GP), (3) referral to the TIA clinic, and (4) atten-dance at the TIA clinic. Associations with age greater (>) and less than (<) 60 were examined using logistic regression. Results: 851 patients were included; of these, the proportion of patients, age <60 years diagnosed with TIA 15.7% (48/306) or stroke 5.6% (17/306) was lower, compared to patients > 60 years of age, 26.4% (144/545) and 10.1% (55/545) respectively. An age of greater than 60 years was also predictive of a positive TIA/stroke diagnosis (OR=1.79, 95% CI 1.24 to 2.58, p=0.005), indepen-dent of the presence of diabetes, cholesterol, hypertension, IHD, PVD, and AF. The mean ABCD2 score, assessed on first presentation to the GP, was lower in the younger (2.68 ± 1.24) compared to the older age group (3.51 ± 1.39) (p<0.001). Despite this, “duration before referral to the TIA clinic” – interval (2) to (3), was shorter in younger, 4.03 ± 15.3 days, compared to 5.85 ± 35.8 days in older patients (p=0.02). Similarly, the “time of receiving the referral, to attendance the TIA clinic” – time interval (3) to (4) was shorter, 0.93 ± 2.82 verses 1.06 ± 3.10 days, but this did not reach statistical significance (p=0.10). Conclusions: An age of > 60 years is associated a delay of referral from the GP to the TIA clinic despite a higher ABCD2 score in these patients. Recognising age differences in referral patterns to the open access TIA clinic, is an important first step to better access for older patients, who are more likely to be diagnosed with a TIA/stroke. 720 © 2013 S. Karger AG, Basel Scientific Programme 712 Acute cerebrovascular events (ACE): TIA and minor strokes Missing the Deadline: Carotid Endarterectomy following Transient Ischemic Attack A. Walker1, K. Grant2 University College London, London, UNITED KINGDOM1, University College London, Lon-don, UNITED KINGDOM2 NICE guidelines (2011) state that carotid endarterectomy (CEA) following transient ischemic at-tack (TIA) is beneficial for prevention of further cerebro-vascular episodes when performed with-in 2 weeks of presentation, in patients with Duplex scans showing 50-99% carotid artery stenosis (NASCET criteria). Our audit aimed to identify the success of University College London Hospital (UCLH), with on-site Hyper-acute Stroke Unit, at achieving this 2-week target. Our study was based on audit data analysed in the form of an observational study. UCLH’s hybrid theatre records were used to find all urgent CEAs performed between August and November 2011 which met criteria for intervention (n=11). By measuring the time intervals during a patient’s journey from presenta-tion, to imaging, to theatre, we aimed to identify the source of delays and corresponding gaps in communication. Results highlighted a NICE guideline success rate of 45%. However, while 100% of Patients who had imaging and MDT discussion before discharge underwent CEA within two weeks, only 17% of patients who were discharged prior to Duplex scan met the two-week deadline. Data for ‘presentation-to-imaging’, and ‘imaging-to-operation’ highlighted that delayed treatment corresponded to delayed imaging (mean days to imaging =5.7 days, s.d. = 7.7). We designed tar-geted interventions that focussed on speeding up this rate-limiting step. To measure the effects of these changes we re-audited the data for procedures performed between January and March 2012 (n=6), including the ‘time from presentation-to-imaging’ data that had been measured previously. Our results showed an overall increase in the proportion of patients who met the 2 week target time (100%), with an accompanying reduction in days from presentation-to-imaging (mean = 2, s.d. = 1.26). This project demonstrated the importance of identifying where treatment delays are occurring, enabling design of specific, targeted interventions to improve patient outcome.


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