Care pathways for low-risk transient ischaemic attack

02 June 2018
Volume 10 · Issue 6



In secondary care, the urgency of review for transient ischaemic attack (TIA) has relied upon the use of the ABCD2 score, but this tool is not validated for use by emergency ambulance crews. There is a need to evaluate alternative care pathways for patients who might be eligible for direct referral to TIA clinics without prior conveyance to the emergency department (ED).


The aim of this national survey was to describe current service provision across the UK for pre-hospital emergency care of patients with TIA.


The authors approached all UK Ambulance trusts (n=13) by email, asking them to provide details of TIA patient referral pathways.


Twelve ambulance services responded to the survey and nine reported that they had no current pathway; one had discontinued a pathway because of service reconfiguration; and three were currently using one. All pathways used the ABCD2 tool to screen patients and classified patients as low-risk if the ABCD2 score was 3 or below. Non-conveyance exclusion criteria varied. Although compliance with referral pathways was audited in an initial pilot in one service, no other evaluations of the effectiveness of pathways were reported.


A minority of UK ambulance services report introducing referral pathways for low-risk TIA patients, avoiding initial assessment in the ED. Safety, effectiveness and acceptability of such pathways have not been evaluated to date.

Early specialist assessment of transient ischaemic attack (TIA) reduces the risk of stroke and death (Giles and Rothwell, 2007; Johnson et al, 2007; Lavellée et al, 2007; Rothwell et al, 2007). The Royal College of Physicians (RCP) and National Institute for Health and Care Excellence (NICE) have guidelines for the management of TIA (RCP, 2010; 2016; NICE, 2017). This includes guidance related to the use of the Face Arms Speech Test (FAST) to exclude stroke (Dombowski et al, 2015).

TIA is defined as:

‘a transient episode of neurologic dysfunction caused by focal brain, spinal cord or retinal ischemia without acute infarction’ (Easton et al, 2009)

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