Transient IschAemic Attack (T.I.A.)

Patients with TIA do not need admission to hospital unless they are high risk and cannot be seen within 24 hours in a TIA clinic (i.e. presenting on a weekend or bank holiday). The ABCD2 Score is used to prioritise the urgency of investigation. The risk of stroke is greatest in the first 7 to 14 days following a TIA.

Any patient with a persisting neurological deficit must be referred to the nearest Hyper Acute Stroke Unit (HASU) and IS NOT appropriate for TIA clinic referral.

A / Age / > 60 years / 1 point
B / Blood pressure / Systolic > 140 or diastolic > 90 mmHg / 1 point
C / Clinical features / Unilateral weakness / 2 points
Speech disturbance without weakness / 1 point
D / Duration / ≥ 60 minutes / 2 points
10 – 59 minutes / 1 point
<10 minutes / 0 points
Diabetes / 1 point
ABCD2
score / Scans (CT scan and carotid dopplers) and
Review appointment in TIA clinic
HIGH risk = 4 or more points, OR 2 or more events in 1 week / Within 24 hours of event
LOW risk = 3 points or less, OR presenting more than 1 week after last symptoms / Within 1 week of event

Referral to TIA clinic

Daily TIA clinics are run by Dr Choy and Dr McNabb, Monday to Friday, at 1330 on the AAU. Fax referral to 020 8934 3884 (and phone extension 3656).

The following information MUST be included in the referral:

  • Patient name, address and telephone numbers (warn patient that they will be contacted the following day by the AAU)
  • Brief clinical history including time/date of onset, examination, risk factors
  • ABCD2 score (see above)
  • All patients should have the following tests requested prior to referral: FBC, U&E, ESR, cholesterol, glucose, LFTs, ECG
  • Unless there is a contraindication, aspirin 300mg daily should be prescribed
  • Patients who have had a stroke or a TIA should be told they must not drive for a minimum of one month.

Weekend high risk patients: Over the weekend/bank holiday when it is not possible to access a TIA clinic within 24 hours, high risk patients should be referred to the Medical SpR on call (bleep 174) and assessed in the AAU. Patients should have their blood tests, ECG, CT brain scan and initiation of appropriate secondary prevention prior to discharge.

Ensure all patient information and the referral are forwarded to the AAU/TIA clinic and ask the patient to phone AAU first thing in the morning on the next working day to confirm their TIA clinic appointment.

Kingston TIA CLINC REFERRAL FORM

Kingston Hospital NHS Trust
TIA CLINIC
REFERRAL FORM
**FAX NUMBER: 02089343884
(Please fax referral urgently)
Stroke team bleep 463 (Stroke registrar) / Source of referral (please ring):
GP / A&E / MAU / Paramedic / Other

Date and time of First Contact with 1st HCP

Date__ /__ /__: time __ : __ (24h clock)
Name of referrer and contact phone number:
Date and time of referral:
Date__ /__ /__: time __ : __ (24h clock)
CLINIC DATE: Date__ /__ /__: time __ : __ (24h clock)
GP STAMP( name and address)
Patient details
Name :
Sex :
D.O.B. :
Address:
Tel. No.:
Carer’s name
Tel: / Date and time of onset of symptom(s)
Date__ /__ /__: time __ : __ (24h clock)
Brief history
Previous TIA’s or Stroke? Yes / No
If yes, when and how many
Handed Left / Right
Preferred language
Interpreter needed Yes / No / Driver Yes / No
Is Hospital transport required? Yes / No
Type required Car Ambulance
ABCD2 SCORE
if presenting within 7 days / POTENTIAL
POINTS / POINTS / Past Medical History:
Age >/=60 / 1
< 60 / 0
BP Systolic >140 or Diastolic ≥ 90 / 1
Systolic <140 & Diastolic < 90 / 0
Clinical features
Unilateral weakness / 2
Speech disturbanceonly / 1
Sensory Loss/ other symptoms / 0
Duration >/= 60 minutes / 2 / Family History:
10 – 59 minutes / 1
< 10 minutes / 0
Diabetes Present / 1 / Social History:
Absent / 0
TOTAL SCORE
If score 4 or above, or more than 1 TIA in a week, or on anticoagulant follow high risk pathway
This pathway is NOT for patients with persisting neurological symptoms.
Current Drug Therapy:
Please start aspirin 300mg of immediately. If aspirin intolerant consider alternative anti-platelet
Please specify:
  • If on Aspirin at time of event and/or other anti-platelet drug(s)
If on Warfarin and why? Most recent INR with date (if known):
Please circle any known additional risk factors:
  • Previous TIA / CVA
  • IHD
  • Known carotid disease
  • Atrial Fibrillation
/
  • Hypertension
  • Diabetes
  • Impaired LV function
  • Alcohol
/
  • Hyper-lipidaemia
  • Smoking Current / Ex (If current number/day)
  • Peripheral vascular disease
  • Obesity