national-clinical-guidelines-for-stroke-fourth-edition

Primary care concise guide for stroke 2012
Primary care concise guide for stroke 2012
These profession-specific concise guidelines contain recommendations extracted from the National
clinical guideline for stroke, 4th edition, which contains over 300 recommendations covering almost every
aspect of stroke management. The recommendations for each profession are given with their numbers,
so that they can be found in the main guideline.
The recommendations below were compiled by Dr Helen Hosker. They aim to provide clinicians
working in primary care with ready access to the latest guidance.
Overall organisation of acute services
(3.1.1)
B All patients seen with an acute neurological
syndrome suspected to be a stroke should be
transferred directly to a specialised hyperacute
stroke unit that will assess for thrombolysis
and other urgent interventions and deliver
them if clinically indicated.
Specialist stroke services (3.2.1)
H All patients after stroke should be screened
within 6 weeks of diagnosis, using a validated
tool, to identify mood disturbance and
cognitive impairment.
Transfers of care – discharge from hospital
(3.8.1)
C Patients being discharged who remain
dependent in some personal activities (eg
dressing, toileting) should have access to, where
appropriate, a transition package of:
● pre-discharge visits (eg at weekends)
● individual training and education for their
carers
● telephone counselling support for 3 months.
End-of-life (palliative) care (3.15.1)
D All patients who are dying should be given the
opportunity of timely/fast-track discharge
home or to a hospice or care home according
to wishes of the patient and/or carers.
Initial diagnosis of acute transient event
(TIA) (4.2.1)
A All patients whose acute symptoms and signs
resolve within 24 hours (ie TIA) should be seen
by a specialist in neurovascular disease (eg in a
specialist neurovascular clinic or an acute
stroke unit).
B People with a suspected TIA, that is, they have
no neurological symptoms at the time of
assessment (within 24 hours), should be
assessed as soon as possible for their risk of
subsequent stroke by using a validated scoring
system such as ABCD 2 .
C Patients with suspected TIA who are at high
risk of stroke (eg an ABCD 2 score of 4 or
above) should receive:
● aspirin or clopidogrel (each as a 300 mg
loading dose and 75 mg thereafter) and a
statin, eg simvastatin 40 mg started
immediately
● specialist assessment and investigation
within 24 hours of onset of symptoms
● measures for secondary prevention
introduced as soon as the diagnosis is
confirmed including discussion of
individual risk factors.
D People with crescendo TIA (two or more
TIAs in a week), atrial fibrillation or those
on anticoagulants should be treated as
being at high risk of stroke (as described
in recommendation 4.2.1C) even though
they may have an ABCD 2 score of 3 or
below.
160 © Royal College of Physicians 2012