London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 733 735 Acute cerebrovascular events (ACE): TIA and minor strokes Estimating Incidence of ambulatory Acute Cerebrovascular Syndrome (ACVS) on Vancouver Island, British Columbia, a geographically circumscribed population A.M.W. Penn1, K.M. Maclure2, M. Penn3, J. Morrison4 Vancouver Island Health Authority Research Centre, Victoria, CANADA1, University of British Columbia, Vancouver, CANADA2, Vancouver Island Health Authority Research Centre, Victoria, CANADA3, Vancouver Island Health Authority Research Centre, Victoria, CANADA4 Background: TIA and mild stroke are often combined under the heading “mild ACVS”. In-patient care is technically unnecessary, as imaging and treatment is increasingly provided in rapid assess-ment units. The current estimate of mild ACVS incidence in Canada is 0.09% (Krueger 2012). Methods: Suspected ACVS cases on Vancouver Island are referred from GPs offices or 12 Emer-gency Departments to an ambulatory Stroke Rapid Assessment Unit (SRAU). A diagnosis of mild ACVS is based on full work-up by a neurologist in the SRAU and 1 year follow up. MRI is em-ployed if needed and available within 3 days of onset (20% MRI rate). “Mild” = not requiring hos-pital admission. Patients who develop stroke after index TIA and are hospitalized before they can attend the SRAU are also counted using the island-wide electronic medical record and by follow-up phone call. Where ACVS is suspected but not proven “possible ACVS” is used. Cases stratified as north or south based on postal code. Populations: south 359,991, north 376,263. Results: For the South, where the SRAU is located, the annual per capita referral for presumed ACVS to the SRAU, grew linearly from 0.13% in 2005 to 0.33% in 2010, with no deceleration. Mimic rate - 44%, “possible ACVS” - 12%. For 2010 the incidence of ACVS plus “possible ACVS” was 0.16%. At present referral growth rates this should exceed 0.24% in 2 more years. The north island saw parallel but delayed growth. 19% of referrals were no-shows in 2010 compared to 2% in 2005. Patients developing recurrent stroke before they could be seen in clinic (3% of referrals in 2010, 1.5% in 2005) increased as TIA-to-clinic performance decreased. Conclusion: Without active case ascertainment, incidence of non-hospitalized confirmed ACVS on Vancouver Island is almost twice the present Canadian estimate, and likely much larger. Referrals grow rapidly when access to specialized care is provided, which may swamp system capacity, reduc-ing the efficacy of such clinics. 736 Acute cerebrovascular events (ACE): TIA and minor strokes DRVING ADVICE GIVEN TO PATIENTS REFERRED TO A TRANSIENT ISCHAEMIC ATTACK (TIA) CLINIC P.G. O’Mahony1, N. Ahad2, V. Jones3 St Helier Hospital, London, UNITED KINGDOM1, St Helier Hospital, London, UNITED KING-DOM2, St Helier Hospital, London, UNITED KINGDOM3 Background The Driver and Vehicle Licensing Authority (DVLA) guidelines indicate that patients with a tran-sient ischaemic attack (TIA) should not drive for one month after the event. Compliance with the guidelines has previously been shown to be poor. We wished to assess the current status on follow-ing the DVLA medical guidance for patients referred to a rapid access TIA clinic. Method All new patients (n =185) referred to our TIA clinic over a 10-month period were asked if they were current drivers, whether or not they had been advised not to drive before attending the clinic and how they had travelled to the clinic that day. Results In total, 94 patients referred were current drivers. Only 13 (14%) had been advised not to drive be-fore attending clinic. 42 (23%) patients actually drove to the clinic, of whom 4 had been advised not to. 63 patients were ultimately diagnosed with TIA, and 25 with stroke, of whom 31 and 9 respective-ly were current drivers. Of those diagnosed with TIA, 16 (25%) drove themselves to the clinic, 2 (13%) of whom had been advised not to. Of the 25 stroke patients, 4 (16%) drove to clinic, of whom one (25%) had been advised appropriately not to. Conclusion Doctors are legally obliged to inform patients if their medical condition means they may be unfit to drive. It is concerning that the vast majority of drivers are not being advised appropriately with im-plications not only for driving safety but also for doctors’ responsibility and duty. Our TIA pathway available to all referrers clearly documents the need to give driving advice. However, doctors need to routinely ask patients about driving in whom they suspect a diagnosis of TIA and advise them ap-propriately. Given the incidence of TIA (0.35% population annually), should there be more public information about driving alongside the successful stroke campaigns?
Karger_ESC London_2013
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