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>>> [log in to unmask] 01/02/01 11:25 >>> 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. Why are you advising these patients to rest in hospital post-LP rather than at home ? Are you still applying the six hours flat on their back post-LP rule ? Who is doing the advising the ED docs or the medics ? 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. I agree the analogy with USA is not that accurate, but I think the JAMA article ( JAMA 248(22) Dec 13 2000, pg2901) was interesting in that it showed that 10 % of TIA patients had a CVA within 90 days, and 50% of those were within the first 48 % hours and identifed some factors associated with increased risk - age > 60, symptoms > 10 mins, diabetes, speech impairment and weekness . So if your next TIA patient has all of those risk factors and a carotid bruit - do they head to the outpatients or do we admit them and doppler them and if necessary send them vascular ? Im not convinced that "discharged to TIA/stroke clinic" is all that appropriate. If you label someone high risk from a coronary point of view - you wouldnt usually consider working them up as an outpatient, so if your high risk from a brain point of view is it anyless acceptable to manage them as an outpatient? ( I understand its not that clear cut, but Im just interested in getting some more opinions ) Craig Dr Craig Ellis Emergency Medicine Registrar Wellington Hospital Wellington, New Zealand CCH Secure Mail Server ******************************************************************************** This email or attachment(s) may contain confidential or legally privileged information intended for the sole use of the addressee(s). Any use, redistribution, disclosure, or reproduction of this message, except as intended, is prohibited. If you received this email in error, please notify the sender and remove all copies of the message, including any attachments. Any views or opinions expressed in this email (unless otherwise stated) may not represent those of Capital Coast Health Ltd. (AC_S001) [INFO] -- Virus Manager: No Viruses were detected in this message. ********************************************************************************