Hospital and demographic influences on the disposition of transient ischemic attack

Objectives: There is substantial variation in the emergency department (ED) disposition of patients with transient ischemic attack (TIA), and the factors responsible for this variation have not been determined. In this study, the authors examined the influence of clinical, sociodemographic, and hospital characteristics on ED disposition. Methods: All ED-treated TIA cases from community hospitals in 11 states were identified from the 2002 Healthcare Cost and Utilization Project (HCUP). Using the aggregate data, descriptive analyses compared admitted and discharged cases. Pearson's chi-square test was used to determine the statistical significance of these comparisons. Based on the results of the bivariate analyses, logistic regression models of the likelihood of hospital admission were derived, using a stepwise selection process. Adjusted risk ratios and 95% confidence intervals (CI) were calculated from the logistic regression models. Results: A total of 34,843 cases were identified in the 11 states, with 53% of cases admitted to the hospital. In logistic regression models, differences in admission status were found to be strongly associated with clinical characteristics such as age and comorbidities. After controlling for comorbidities, differences in admission status were also found to be associated to hospital type and with sociodemographic characteristics, including county of residence and insurance status. Conclusions: While clinical factors predictably and appropriately impact the ED disposition of patients diagnosed with TIA, several nonclinical factors are also associated with differences in disposition. Additional research is needed to better understand the basis for these disparities and their potential impact on patient outcomes.