Authors (including presenting author) :
Chui KS(1), Chan YS(1), Ho PC(1), Duong KH(1), Mok YNM(1), Li R(1), Cheng WH(1), AuYeung M(1), Cheung CM(1)
Affiliation :
(1)Department of Medicine, Pamela Youde Nethersole Eastern Hospital
Keyword 1: :
Carotid stenosis
Keyword 2: :
Triage checklist
Keyword 3: :
Patient stratification
Keyword 4: :
Readmission reduction
Keyword 5: :
Diagnostic yield
Keyword 6: :
Resource allocation
Introduction :
Carotid artery stenosis is a modifiable risk factor for acute ischaemic stroke (AIS) and transient ischemic attack (TIA). Timely detection through ultrasound carotid doppler (CD) is essential for risk stratification and intervention, but resource constraints in busy hospitals necessitate prioritization for inpatient imaging. Structured triage protocols are crucial for optimizing outcomes and resource use.
Objectives :
To evaluate the effectiveness of a structured clinical checklist in prioritizing inpatient and outpatient CD in AIS and TIA patients, focusing on improved diagnostic outcome and intervention rate, reduced three-month stroke-related unplanned readmissions (SUR).
Methodology :
A retrospective observational cohort study was conducted at Pamela Youde Nethersole Eastern Hospital, reviewing 3,605 AIS and TIA admissions from January 2022 to October 2025. A structured checklist incorporating stroke type, conscious level, post-stroke modified Rankin Scale, stroke symptoms, and age was used to prioritize patients for inpatient CD. Patients deemed lowest priority did not undergo CD due to limited expected benefit from stenting. The checklist was collaborated with the neurology team to ensure patient selection, safety and continuity of care. Outcomes included detection of significant carotid stenosis (≥50%), follow-up computed tomography angiograms (CTA), subsequent carotid stenting, and three-month SUR. Statistical analysis utilized chi-square tests and odds ratio calculations.
Result & Outcome :
Of 3,605 patients, 2,190 (60.8%) were classified as high priority. Significant carotid stenosis was detected in 247 patients (11.3%), with 240 (97.1%) undergoing CTA and 49 receiving elective stenting. High-priority patients had a significantly lower three-month SUR (8 vs 31 cases in low-priority group, odds ratio: 0.37, p = 0.033). High-priority patients unable to complete CD during hospitalization had their outpatient appointment CD advanced to 4–6 weeks instead of standard 12-week interval, ensuring earlier diagnosis and intervention. Operational realities caused minor overlaps, some lower-priority patients receiving CD when slots were available and some high-priority patients missing CD due to condition or resource constraints. Implementing the checklist improved detection of high-grade stenosis, enabled timely follow-up and intervention, reduced unplanned readmissions. These findings support the clinical utility of structured checklist to optimize resource allocation, enhance stroke care efficiency, and improve long-term patient outcomes.
