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Are patients afraid to go home? Disposition preferences after transient ischaemic attack and minor stroke
  1. Bernard P Chang1,
  2. Talea Cornelius2,
  3. Joshua Willey3,
  4. Donald Edmondson2,
  5. Mitchell SV Elkind3,
  6. Ian M Kronish2
  1. 1 Emergency Medicine, Columbia University Medical Center, New York, New York, USA
  2. 2 Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York, USA
  3. 3 Neurology, Columbia University, New York, New York, USA
  1. Correspondence to Dr Bernard P Chang, Emergency Medicine, Columbia University Medical Center, New York, NY 10032, USA; bpc2103{at}columbia.edu

Abstract

Background Recent evidence suggests clinical equipoise for managing transient ischaemic attack and minor stroke (TIAMS) either via discharge from the emergency department (ED) with rapid outpatient follow-up or inpatient admission. Understanding patient preferences may guide decision-making around disposition after TIAMS that can lead to higher patient satisfaction and adherence. Psychological distress, particularly a sense of vulnerability (eg, ‘threat perception’) is associated with adverse psychological outcomes following TIAMS and may influence patient disposition preference. We hypothesised patients with higher threat perceptions in the ED would prefer inpatient admission versus early discharge with rapid outpatient follow-up.

Methods This was a planned secondary analysis of a prospective observational cohort study of ED patients with suspected TIAMS (defined as National Institutes of Health Stroke Scale (NIHSS) score of ≤5). Patients reported disposition preferences and completed a validated scale of threat perception while in the ED (score range: 1–4).

Results 147 TIAMS patients were evaluated (mean age: 59.7±15.4, 45.6% female, 39.5% Hispanic, median NIHSS=1, IQR: 0, 3). A majority of patients (98, 66.7%) preferred inpatient admission compared with discharge from the ED. Overall threat scores were median 1.0 (IQR: 0.43, 1.68). Those preferring admission had similar threat scores compared with those who preferred early disposition (median: 1.00, IQR: 0.43, 1.57) versus 1.00, (IQR: 0.49, 1.68); p=0.40). In a model adjusted for demographic characteristics, threat perceptions remained unassociated with disposition preference.

Conclusion Overall, two-thirds of TIAMS patients preferred inpatient admission over discharge. Disposition preference was not associated with higher threat perception in the ED. Further research examining potential drivers of patient disposition preferences may inform patient discussions and optimise patient satisfaction.

  • neurology
  • stroke
  • psychology
  • patient support
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Footnotes

  • Contributors BPC, IMK, JW, ME and DE conceived the study. BPC, IMK, DE obtained research funding. IMK, JW, ME, TC supervised the study and data collection. TC and DE provided statistical advice and drafted the manuscript, and all authors contributed substantially to its revision. BPC and IMK take responsibility for the paper as a whole.

  • Funding This work was supported by HL141811, HL132347 from NIH/NHLBI.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Institutional Review Board of Columbia University.

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

  • Data availability statement Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. The data are de-identified participant data. Please contact the corresponding author of this study (Bernard Chang MD PhD: bpc2103@columbia.edu) for any data requests related to academic and scientific inquiry.

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