To identify clinical features that differentiate true ischemic events from nonischemic transient neurological attacks (NI-TNAs) among patients admitted to an ED-Observation Unit (ED-OU) for suspected TIA.

Transient neurologic events have high rates of diagnostic uncertainty. ED-OUs allow an accelerated diagnostic work up for suspected transient ischemic attacks (TIAs). However, clinical decision support regarding which patients to admit to these units is lacking.

A retrospective analysis was performed on consecutive patients admitted to the ED-OU at a single academic center for suspected TIA. Demographics, vascular risk factors, presenting symptoms, and clinical presentation details were abstracted from chart review. Final discharge diagnosis was dichotomized to either TIA or minor stroke (TIAMS) or NI-TNA based on the treating vascular neurologist’s final diagnosis. Standard statistical tests were used for comparison testing between the groups. Significantly different factors on univariate analysis were applied to a multivariable logistic regression model.

We identified two clinical features that distinguished TIAMS from NI-TNA among patients admitted to an ED-OU for suspected TIA. These may be helpful in emergency room triage of TIAMS. Data from ED-OU can be used to identify factors associated with cerebral ischemia and improve current care pathways for patients with suspected TIA, so diagnostic evaluation is received in the most appropriate setting.