Making every clinic slot count: Are we using the History Other than TIA (HOTTIA) clinic efficiently?

Introduction  

Current NICE guidelines recommend urgent specialist assessment of patients with suspected transient ischaemic attack (TIA), to confirm or refute the diagnosis. However, in practice, many patients may have an alternative diagnosis. At Leeds Teaching Hospital NHS Trust (LTHT), patients with atypical features who are triaged as less likely to have a TIA may be referred to HOTTIA clinic. Understanding referral patterns and diagnostic outcomes may help identify patients better suited to alternative clinical pathways. 

Method 

A retrospective review conducted of patients in HOTTIA clinic at LTHT between August 2025 and February 2026.  Data collected included source of referral, triage diagnosis, clinic diagnosis, investigations and clinic outcomes. 

Results 

A total of 200 patients were reviewed. Referrals originated from GP (38.5%), Emergency department (28.5%), TIA clinic (17.5%), inpatient services (8.5%) and other sources (7%). 56% of patients were discharged from this clinic after review. The most common diagnosis suggested at triage was TIA and migraine. Overall, 53% of patients were diagnosed with stroke mimic following HOTTIA clinic, of whom migraine was the most common diagnosis (39.5%). A diagnosis of migraine at triage was confirmed following clinic assessment in 85% of cases, compared with 23% of patients in which a diagnosis of TIA at triage was confirmed following clinic assessment.  

Conclusion  

This review identifies diagnostic heterogeneity amongst HOTTIA referrals, with stroke mimics such as migraine representing common alternative diagnoses. The high diagnostic concordance for migraine at triage with the clinic diagnosis supports the importance of senior clinician review at point of referral to identify suitable alternative pathways for patients. This can improve efficiency of patient care and optimise resource allocation by reducing unnecessary HOTTIA clinic referrals. These findings are informing ongoing refinement of triage and referral criteria, with senior clinician input guiding the development of appropriate alternative clinical pathways at LTHT.