Article Text

Download PDFPDF
Emergency department or general practitioner following transient ischaemic attack? A comparison of patient behaviour and speed of assessment in England and Canada
  1. Dulka Manawadu1,
  2. Ashfaq Shuaib1,
  3. David M Collas2
  1. 1Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
  2. 2Department Medicine for the Elderly, Watford General Hospital, Watford, UK
  1. Correspondence to David M Collas, Watford General Hospital, Vicarage Road, Watford, Hertfordshire WD18 0HB, UK; david.collas{at}


Objective Many patients present late after a transient ischaemic attack (TIA). This delays intervention and may partly depend on where patients first present—emergency department (ED) or general practitioner (GP). Studying this behaviour could improve stroke prevention through better targeting of public education and allocation of resources.

Methods Patients with TIA or minor stroke referred to neurovascular clinics in the UK and Canada were studied and the delay from onset to first medical presentation, whether at an ED or GP, was measured. Clinical features, timing and place of presentation were compared.

Results Of 666 patients (469 in the UK and 197 in Canada), only 42% presented on the day of the TIA. The majority (77%) of patients presenting to an ED presented on the same day compared with only 11% of those who presented to a GP. GP delays were longer at weekends. Motor or speech symptoms and prolonged duration were associated with presenting early and to an ED. High-risk patients (ABCD2 score 6–7) in Canada were also more likely to go to an ED. Overall, 65% of Canadian patients and 40% of UK patients went to an ED.

Conclusions Most patients presenting to an ED go urgently, whereas most going to a GP delay, particularly at weekends. Most Canadian patients, particularly those at high risk, go to an ED whereas most UK patients go to a GP. One way to reduce delay, particularly in the UK, would be to direct all patients with TIA to go to an ED rather than to their GP.

  • Ischaemic attack, transient
  • stroke
  • risk reduction behaviour
  • time factors
  • prevention
  • acute medicine-others
  • emergency care systems, primary care
  • emergency care systems, emergency departments
  • neurology, stroke, nursing, pre-hospital

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.