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Again, you’re trying to add qualifications to #2 an 3 and turn it into something that never happened. Stop trying to make it sound better than it was. There was never a CTA or MRI ordered in the ED - just a non con head CT. No anti-platelet therapy was given.2. Would argue that it is not the standard of care to admit TIA (standard of care has varied regionally). Confirmed stroke. yes. Work it up, definitely. CT, CTA, EKG, cardiac monitoring and close follow up w/ neurology. Many times we are able to get MRI in the ED as well. Yes we use ABCD2 score, but have not agreed w/ neurology on a better validation tool a this time.
3. would have admitting patient 3 days earlier prevented the devastating posterior stroke? Or just optics better? Completing a CTA/MRI and starting pt on DAPT may still have ended up in same result for that patient.
Having said that, I’d like to explore some of your logic here. Tell me how you are “confirming” a posterior stroke vs TIA in the ED as a means to determine who needs to be admitted. Better yet, why are you trying to do this?