Clinical inquiries. Is an outpatient workup safe for patients with a transient ischemic attack?

■ EVIDENCE-BASED ANSWER There is no compelling evidence that outpatient diagnostic workup of patients with transient ischemic attack (TIA) is less safe than inpatient workup, or that hospitalization prevents stroke or improves stroke outcomes after TIA (strength of recommendation [SOR]: C, based on case series studies). Because the risk of stroke is substantial in the week following a TIA (SOR: A, based on a prospective cohort study), evaluation and treatment for reversible stroke risk factors should be initiated urgently and completed within a week of initial presentation (SOR: C, based on expert consensus opinion). Risk factors for patients at highest risk for stroke or other cardiovascular events after TIA include age >60 years, diabetes, TIA lasting longer than 10 minutes, and a TIA associated with weakness or speech impairment (SOR: B, based on retrospective cohort study). Hospitalization may be prudent for patients at high risk for cardiovascular events or for those with mental status changes, an inadequate home situation, or the physician’s inability to obtain expedient evaluation (SOR: C, based on case series studies).