Evaluation of the Effectiveness of a City Hospital Care Network for the Care of Patients With Transient Ischemic Accident (TIA)
试验速览
- 阶段
- 不适用
- 发起方
- 入组人数
- 51
- 试验地点
- 1
- 主要终点
- The objective of the research is to study the feasibility of outpatient treatment for TIA from the emergency room, by evaluating the percentage of patients who have completed 100% of the additional examinations included in the course.
研究概览
简要总结
Transient ischemic accidents (TIA) are a frequent resort to hospitalization in the emergency department and are serious events in terms of recurrence and handicap. The organization of the "TIA sector" at CHUGA aims to facilitate on the one hand the care of the patient during his hospitalization in the emergencies and on the other hand to allow a safer discharge of the patient as well as his follow-up in ambulatory. The aim of this study is to study the feasibility of comprehensive short-term outpatient management after hospitalization in the emergencies. The research hypothesis is that 90% of patients complete all of the 10 recommended examinations for the diagnosis of TIA, analysis of its risk factors and initiation of necessary treatments, if necessary.
详细描述
Current knowledge on pathology Transient ischemic accidents (TIA) are a frequent resort to hospitalization in the emergency department (378 visits in 2019 to the CHUGA emergencies, 340 in 2020, or about 1 entry for this reason per day) and are serious events in terms of recurrence and handicap. The risk of Cerebral Vascular Accident (stroke) is around 10% at 3 months after the first episode of TIA [1]. Standardizing care and improving patient compliance with treatment and monitoring of their pathology aims to reduce the recurrence and the occurrence of more serious consequences.
In 2021, the Northern Alpine Emergency Network (RENAU) published standardized care for all hospitals and clinics dependent on this network, based on the French recommendations of the Haute Autorité de Santé and the French Neurovascular Society (SFNV).
This care was put in place at the Emergency Department of the CHU Grenoble Alpes (CHUGA) in the form of an "TIA program" and defines the patient's journey when he presents signs compatible with the suspicion of TIA. In addition to being based on national and regional recommendations, this sector has been improved by providing a questionnaire to all Neuro-Vascular Units (NVU) in France.
The organization of the "TIA sector" at CHUGA aims to facilitate on the one hand the care of the patient during his hospitalization in the emergency room and on the other hand to allow a safer discharge of the patient as well as his follow-up in ambulatory.
For example, a Parisian study, carried out at the Bichat hospital [2], showed that a standardized treatment pathway for TIAs was linked to a reduction of more than 30% in the risk of stroke 3 months after the TIA.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Hospitalization in the Emergency Department of the CHUGA for suspicion of TIA
- •Possible or probable TIA diagnosis on discharge
- •Major patient
- •Outpatient care after emergency care
排除标准
- •Protected patient (guardianship, curatorship, people not affiliated with Social Security)
- •Patient deprived of liberty by a judicial or administrative decision
- •Patient hospitalized without consent under Articles L. 3212-1 and L. 3213-1 which does not fall under the provisions of Article L. 1121-8
- •Adult patient subject to a legal protection measure or unable to express consent
- •Pregnant, lactating or parturient women
- •Patient who does not speak French
- •Inability to answer the phone to answer questions
- •No attending physician
结局指标
主要结局
The objective of the research is to study the feasibility of outpatient treatment for TIA from the emergency room, by evaluating the percentage of patients who have completed 100% of the additional examinations included in the course.
时间窗: 6 months
The primary endpoint is the mandatory completion of the 10 items recommended by the SFNV and the RENAU, as part of the diagnosis and management of TIA: 1. Recommended standard biology (including assessment of cardiovascular risk factors) 2. The electrocardiogram 3. Brain imaging 4. Imaging of the supraortic trunks 5. The summary of all examinations by a neurologist 6. The introduction of antiplatelet therapy 7. The introduction of statins 8. The follow-up consultation with the attending physician in the month following discharge from the emergency room. 9. Consultation with a cardiologist, with performance of an echocardiography and a Holter ECG 10. Performing a brain MRI
次要结局
- Identify complications at one month including a recurrence of TIA or stroke(6 months)
- Identify the barriers to membership in the care sector(6 months)
- Evaluate the patient's adherence and understanding to the care sector(6 months)
- Identify the additional examinations that are not performed during the patient's care, and the difficulties in carrying out the standardized care offered to the Emergency Department(6 months)