Michael Ross

Emory University, Atlanta, GA, United States

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Publications (3)5.2 Total impact

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    ABSTRACT: This study examined the impact of an emergency department (ED) observation unit's accelerated diagnostic protocol (ADP) on hospital length of stay (LOS), cost of care, and clinical outcome of patients who had sustained a transient ischemic attack (TIA). All patients with TIA presenting to the ED over a 18-consecutive month period were eligible for the study. During the initial 11 months of the study (pre-ADP period), all patients were admitted to the neurology service. Over the subsequent 7 months (post-ADP period), patients were either managed using the ADP or were admitted based on ADP exclusion criteria or at a physician's discretion. All patients had orders for serial clinical examinations, neurologic evaluation, cardiac monitoring, vascular imaging of the brain and neck, and echocardiography. A total of 142 patients were included in the study (mean age, 67.9 ± 13.9 years; 61% female; mean ABCD(2) score, 4.3 ± 1.4). In the post-ADP period, 68% of the patients were managed using the ADP. Of these patients, 79% were discharged with a median LOS of 25.5 hours (ED + observation unit). Compared with the pre-ADP patients, the post-ADP patients (ADP and non-ADP) had a 20.8-hour shorter median LOS (95% confidence interval, 16.3-25.1 hours; P < .01) than pre-ADP patients and lower median associated costs (cost difference, $1643; 95% confidence interval, $1047-$2238). The stroke rate at 90 days was low in both groups (pre-ADP, 0%; post-ADP, 1.2%). Our findings indicate that introduction of an ED observation unit ADP for patients with TIA at a primary stroke center is associated with a significantly shorter LOS and lower costs compared with inpatient admission, with comparable clinical outcomes.
    Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 04/2011;
  • Michael Ross, Fadi Nahab
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    ABSTRACT: Patients who have a transient ischemic attack (TIA) represent a group that may appear well but are at high risk for stroke within 90 days. Management of patients who have a TIA requires an understanding of the short-term risk for stroke to guide acute management and the long-term benefits to medical and surgical therapies. The initial emergency department (ED) evaluation may be supplemented with simple TIA stroke risk scores to estimate short-term stroke risk. The addition of MRI provides yet more information regarding stroke risks, while identifying some specific causes of TIA. Extended testing may not be feasible in the ED, and to address this limitation, new outpatient strategies for patients who have a TIA have been developed, such as the use of an ED observation unit or an outpatient TIA clinic. Although controversy remains in some areas of acute TIA management because of the lack of evidence from controlled trials, evidence from large randomized trials have led to a better understanding of effective measures for the long-term prevention of stroke.
    Emergency medicine clinics of North America 03/2009; 27(1):51-69, viii. · 0.96 Impact Factor
  • Source
    Brett Cucchiara, Michael Ross
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    ABSTRACT: A major challenge facing the physician evaluating patients with transient ischemic attack is determining which patients are at highest short-term risk of stroke. A number of stratification schemes have been recently developed incorporating easily obtainable clinical information about the individual patient. Further, emerging data suggest a role for brain and vascular imaging in risk stratification. Many aspects of acute management of transient ischemic attack, such as which patients should be hospitalized and choice of acute antithrombotic therapy, remain controversial because of a lack of evidence from controlled trials. For longer-term prevention, there is much firmer evidence from multiple large randomized trials, and these data are reviewed in this article.
    Annals of emergency medicine 08/2008; 52(2):S27-39. · 4.23 Impact Factor

Publication Stats

6 Citations
5.20 Total Impact Points


  • 2008–2011
    • Emory University
      • • Department of Neurology
      • • Department of Emergency Medicine
      Atlanta, GA, United States
    • Hospital of the University of Pennsylvania
      • Department of Neurology
      Philadelphia, Pennsylvania, United States