This study aimed to examine outcome in low risk transient ischaemic attack (TIA) 
patients presenting to emergency departments (ED) in a regional Australian 
setting discharged on antiplatelet therapy with expedited neurology review. All 
patients presenting to Gosford or Wyong Hospital ED with TIA, for whom faxed 
referrals to the neurology department were received between October 2008 and 
July 2010, were included in this prospective cohort study. Classification of low 
risk was based on an age, blood pressure, clinical features, duration of 
symptoms and diabetes (ABCD2) score <4 and the absence of high risk features, 
including known carotid disease, crescendo TIA, or atrial fibrillation. Patients 
with ABCD2 scores > or =4 or with high risk features were discussed with the 
neurologist on call (a decision regarding discharge or admission was then made 
at the neurologist's discretion). Patients were investigated with a brain CT 
scan and/or CT angiography, routine pathology, and an electrocardiogram. All 
discharged patients were commenced on antiplatelet therapy and asked to follow 
up with their local medical officer within 7 days. The patients were contacted 
by the neurology department to arrange follow-up. Our primary outcome was the 
number of subsequent strokes occurring within 90 days. Of 200 discharged 
patients for whom referrals were received, three patients had a stroke within 90 
days. None of these would have been prevented through hospitalisation. In 
conclusion, medical assessment, expedited investigation with immediate 
commencement of secondary prevention and outpatient neurology review may be a 
reasonable alternative to admission for low risk patients presenting to the ED 
with TIA.