Abstract TP301: Patient Preferences for Inpatient vs Outpatient Management of TIA and Minor Stroke and Its Association With Psychological Stress

Abstract

Introduction: Understanding patient preferences may help guide decision making around discharge timing after TIA or minor stroke (TIAMS) and may lead to treatment algorithms with higher patient satisfaction and adherence. Psychological stress, particularly a sense of helplessness and vulnerability (defined as “threat perception”) may be associated with adverse psychological outcomes following TIAMS, including the development of post-traumatic stress. We hypothesized that TIAMS patients with higher threat perception would be more likely to prefer inpatient care over early emergency department (ED) discharge. Methods: We analyzed ED patients in a large urban academic medical center with suspected TIAMS (defined as National Institutes of Health Stroke Scale (NIHSS) score of ≤5). Patients reported discharge preferences and completed a validated 7 item self-report scale of threat perception (e.g. “I am worried I am going to die. I feel helpless”). Results: 302 suspected TIAMS patients were evaluated (mean age: 63.7±15.1, 52% female, 24.8% Black, 48% Hispanic, median NIHSS= 2). 217 patients (70.7%) preferred hospital admission compared to ED discharge. In unadjusted analysis, those who preferred admission had similar ED threat scores compared to those who preferred early discharge (8.1 ±5.2 vs 7.2±4.8; p=0.24). In the adjusted model, threat perceptions remained unassociated with discharge preference, however, women and Hispanics were more likely to prefer inpatient admission (Table 1) Conclusion: Overall, TIAMS patients preferred inpatient admission over early discharge. Discharge preference was not associated with higher threat perception. Further research examining potential drivers of patient preferences may inform patient discussions and optimize patient satisfaction with rapid outpatient TIAMS care.