Journal of Primary Health Care Journal of Primary Health Care Society
Journal of The Royal New Zealand College of General Practitioners
RESEARCH ARTICLE (Open Access)

Diagnosis and management of transient ischemic attacks in primary care: a systematic review

Priyanka Bose 1 , Andrew Wilson 1 , Amit Mistri 1
+ Author Affiliations
- Author Affiliations

1 University of Leicester, Health Sciences Centre for Medicine, Leicester, UK

Correspondence to: Priyanka Bose, University of Leicester, Health Sciences Centre for Medicine (Floor 3, Room 3.06), 15 Lancaster Road, Leicester LE1 7HA 0116 252 5449, UK. Email: pb274@le.ac.uk

Journal of Primary Health Care 9(2) 114-130 https://doi.org/10.1071/HC17003
Published: 30 June 2017

Journal Compilation © Royal New Zealand College of General Practitioners 2017.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Abstract

INTRODUCTION: Many patients who suffer a transient ischaemic attack (TIA) present to their general practitioner (GP). Early identification and treatment reduces the risk of subsequent stroke, disability and mortality.

AIM: To review the accuracy of TIA diagnosis in primary care, immediate management and interventions to assist GPs with the condition.

METHODS: This study included the search of Medline, Embase, Web of Science and Scopus databases (1995–2015). Relevant titles and abstracts were obtained using structured criteria (diagnosis, immediate management or intervention of TIAs in primary care), with full review and data extraction for eligible publications.

RESULTS: Most studies found limitations in GPs’ knowledge and ability to diagnose TIAs to varying extent over time and between countries. GPs tended to over-interpret non-specific symptoms (e.g. isolated vertigo) when considering a TIA diagnosis. Reported referral behaviour varied between countries, with some favouring admission and others preferring outpatient management. Consistent under-referral and under-use of effective medication was reported. However, GPs may refer some patients to exclude rather than confirm a final diagnosis. This, alongside evidence of under-referral, suggests the need for education and decision support tools to enhance referral patterns. Intervention studies suggested that electronic decision support may increase referrals and timely management.

CONCLUSION: This review revealed deficiencies in knowledge and clinical practice, and identified potential avenues to addressing these. Issues for future research were also identified.

KEYWORDS: TIA; diagnosis; management; primary care; systematic review


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