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Delay in patients suspected of transient ischaemic attack: a cross-sectional study
  1. L Servaas Dolmans1,
  2. L Jaap Kappelle2,
  3. Marie-Louise EL Bartelink1,
  4. Arno W Hoes1,
  5. Frans H Rutten1
  1. 1 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
  2. 2 Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
  1. Correspondence to Dr L Servaas Dolmans; l.s.dolmans{at}


Objectives Suspected transient ischaemic attack (TIA) necessitates an urgent neurological consultation and a rapid start of antiplatelet therapy to reduce the risk of early ischaemic stroke following a TIA. Guidelines for general practitioners (GPs) emphasise the urgency to install preventive treatment as soon as possible. We aimed to give a contemporary overview of both patient and physician delay.

Methods A survey at two rapid-access TIA outpatient clinics in Utrecht, the Netherlands. All patients suspected of TIA were interviewed to assess time delay to diagnosis and treatment, including the time from symptom onset to (1) the first contact with a medical service (patient delay), (2) consultation of the GP and (3) assessment at the TIA outpatient clinic. We used the diagnosis of the consulting neurologist as reference.

Results Of 93 included patients, 43 (46.2%) received a definite, 13 (14.0%) a probable, 11 (11.8%) a possible and 26 (28.0%) no diagnosis of TIA. The median time from symptom onset to the visit to the TIA service was 114.5 (IQR 44.0–316.6) hours. Median patient delay was 17.5 (IQR 0.8–66.4) hours, with a delay of more than 24 hours in 36 (38.7%) patients. The GP was first contacted in 76 (81.7%) patients, and median time from first contact with the GP practice to the actual GP consultation was 2.8 (0.5–18.5) hours. Median time from GP consultation to TIA service visit was 40.8 (IQR 23.1–140.7) hours. Of the 62 patients naïve to antithrombotic medication who consulted their GP, 27 (43.5%) received antiplatelet therapy.

Conclusions There is substantial patient and physician delay in the process of getting a confirmed TIA diagnosis, resulting in suboptimal prevention of an early ischaemic stroke.

  • stroke
  • neurology
  • organisation of Health services

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  • Contributors LD is a PhD candidate and the primary researcher. LD and FR drafted the manuscript. MB, LK and AW have revised it critically, and all authors approved the final manuscript.

  • Funding The primary researcher (Dr L.S. Dolmans) performed this study as a general practitioner in training, and combined his training with a PhD track. ‘Stichting Beroepsopleiding Huisartsen (SBOH)’, employee of Dutch GP trainees (financially) supported the PhD track.

  • Competing interests None declared.

  • Ethics approval This study was approved by the Medical Research Ethics Committee of the University Medical Center of Utrecht, the Netherlands. Formal ethical approval was not required and the committee waived the requirement to obtain formal informed consent. All participants gave their oral consent.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

  • Patient consent for publication Not required.

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