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Journal Club: It's Not Just a Headache

RAVEN Approach for Outpatient Management of Minor Stroke and TIA

Chang, Bernard P., et al. “Safety and Feasibility of a Rapid Outpatient Management Strategy for Transient Ischemic Attack and Minor Stroke: The Rapid Access Vascular Evaluation–Neurology (RAVEN) Approach.” Annals of Emergency Medicine, vol. 74, no. 4, 2019, pp. 562–571., doi:10.1016/j.annemergmed.2019.05.025.


This study is designed out of the Columbia University Irving Medical Center to investigate the feasibility of implementing an out patient clinic for the management of minor stroke and TIA. A clinic was created for the sole purpose of managing TIA and Stroke with NIHSS > 5 as outpatients to determine if this could potentially be a safe alternative to admission for such patients. Through our discussion, we noted that while this may seem feasible at certain institutions, there are certainly many it is not a possibility due to lack of resources, the likelihood of losing patients to follow up, and different patient demographics. We agreed it would certainly be a useful tool if possible and look forward to further research on the subject. 



Missed Serious Neurologic Conditions in Discharged ED Patients with Headache or Back Pain

Dubosh, Nicole M., et al. “Missed Serious Neurologic Conditions in Emergency Department Patients Discharged With Nonspecific Diagnoses of Headache or Back Pain.” Annals of Emergency Medicine, vol. 74, no. 4, 2019, pp. 549–561., doi:10.1016/j.annemergmed.2019.01.020.


This retrospective analysis looks into the most likely missed diagnosis when patients are discharged with a diagnosis of back pain or headache. With these complaints being extremely common in the ED, the authors looked to compare how the poor outcomes in these cases compare to other common chief complaints and to determine what the most likely serious missed diagnosis are in the emergency department. Our discussion found that the miss rate is seemingly acceptable and in line with other common chief complaints. However, there are some missed diagnosis we will certainly be considering with additional scrutiny at the time of discharge.


September Journal Club Discussion Leader: Nicholas Mandelis, DO (PGY-2)

2019-2020 Academic Year Journal Club Leaders: Sarah Balog, DO (PGY-3); Rose Solomon, DO (PGY-2); David Andonian, MD (Faculty Advisor)

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