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We have a CDU in Manchester, although its effectiveness is usually compromised by being full of medical patients waiting for beds for hours and hours. There are a number of conditions that are suitable for rule in / rule out strategies within 6 hours (our working time scale for CDU type patients). We rule out myocardial infaction in all low and moderate risk chest pain patients with a 6 hour strategy DVT investigation and management is done within the A+E department. A pleuritic chest pain protocol is soon to start. Many OD's can be managed within a 6 hour window. There are clearly many others as well. Headache is my own interest and tends to fall down a little if an LP is required as these patients are advised to rest for a period beyond our working window. The protocols are designed as evidence based rule in/ rule out. There is still a huge amount of work to do on the protocols. TIA is not really the same as unstable angina, although there is the description of "stutttering TIA's", which is an increase in frequency of TIA's, or multiple events that is more in keeping with cerebral unstable angina. There is little reason why a single TIA event cannot be investigated as an out patient. With appropriate support from services such as the vascular labs then the initial TIA work up could be completed fairly rapidly in A+E. Other investigations as an out patient with follow up in a stroke clinic. Such a system operated successfully in a hospital I previously worked in. Simon Carley SpR in Emergency Medicine Manchester Royal Infirmary England [log in to unmask] Evidence based Emergency Medicine http://www.bestbets.org ----- Original Message ----- From: Adrian Kerner <[log in to unmask]> To: <[log in to unmask]> Sent: Monday, January 01, 2001 8:43 PM Subject: Re: TIA > I know how I would like my mum managed! > > TIA is the equivalent of cerebral unstable angina. Surely it should mandate > admission - at very least to arrange/perform duplex etc and assess the need > for surgical intervention. > > These patients could be assessed by 'us' in a 'Clinical Decision Unit'. > Such a CDU is being set up at St James in Leeds. > > It will be interesting to see the effect of such a 'unit' on the number of > carotid endarterectomy performed, before and after opening! > > Other problems to be dealt with on the CDU will include > > Pleuritic chestpain > Swollen legs > Headache. > > Has anyone on the list any experience of a CDU? > > Regards > > Adrian Kerner > SpR > A&E St. James Leeds >