Design: Retrospective repeated cross-sectional study, national sample
Population: About 2.15 million weighted US emergency visits for TIA, 2013–2021
Primary outcome: Emergency department discharge, imaging use and cost
Effect: Discharge 45% to 66%; CTA in discharged patients 4% to 45%; MRI 17% to 53%

This repeated cross-sectional study used a nationally representative sample of US emergency department visits from 2013 to 2021, covering about 2.15 million weighted visits for TIA.

The predicted probability of discharge from the emergency department rose from 45% to 66%. Among discharged patients, CT angiography rose from 4% to 45% and MRI from 17% to 53%, and mean charges per visit rose from about $1,750 to $2,755. Rural departments discharged more patients and used MRI less.

The interpretation is that rapid TIA evaluation now often happens in the emergency department rather than through a short admission. That is efficient where imaging and same-day follow-up exist; where they do not, discharge without vessel imaging leaves the highest-risk patients — those with carotid stenosis or atrial fibrillation — unidentified during the period of greatest stroke risk.

A TIA patient discharged from the emergency department still needs vessel imaging and cardiac rhythm assessment within days.
Start antiplatelet therapy and statin at the first contact unless there is a reason not to.
Where same-day imaging is unavailable, arrange a rapid-access TIA clinic or admit those at higher risk.
Record who is responsible for follow-up in the discharge letter.

Why it matters

Faster discharge shifts responsibility for completing the work-up onto systems that may not be in place.

The statistics, in plain English

These are predicted probabilities from adjusted national models, describing what happened across many hospitals; they do not show whether patients did better or worse.