Clinical Guidelines for Acute Stroke Management - Living on the EDge

2. Pre-Hospital Care
c) Rural practitioners should participate in networks
linking them to regional or metropolitan centres with
specialty in stroke care. ( )
1.11: Standardised assessment
a) Clinicians should use validated and reliable
assessment tools or measures that meet the
needs of the patient and guide clinical decision
making. ( )
b) Clinicians should provide timely and efficient
assessment of patients with acute stroke. Where
possible a multidisciplinary assessment should be
undertaken and documented within two days of
admission. ( )
c) Assessment findings should be discussed at the team
meeting and communicated to the patient and
family/carer in a timely and appropriate manner. ( )
1.12: Palliation and death
a) A pathway <strong>for</strong> acute stroke palliative care may be
used to improve palliation <strong>for</strong> people dying after
acute stroke. (Grade D; Level IV 71 )
b) An accurate assessment of imminent death
should be made <strong>for</strong> patients with severe stroke or
those who are deteriorating. Any assessment must
consider prognostic risk factors along with the
wishes of the patient and their family/carer. ( )
c) <strong>Acute</strong> stroke patients should have access to
specialist palliative care services as needed. ( )
d) People with stroke who are dying, and their
families, should have care that is consistent with
the principles and philosophies of palliative care. ( )
1.13: <strong>Stroke</strong> service improvement
a) All acute stroke services should be involved in
quality improvement activities that include regular
audit and feedback (‘regular’ is considered at least
every two years). (Grade B; Level I 77 )
b) Indicators based on nationally agreed standards of
care should be used when undertaking any audit.
Per<strong>for</strong>mance can then be compared to similar
stroke services as described by the National <strong>Stroke</strong>
Unit Program. ( )
a) Ambulance services, health care professionals
and the general public should receive education
concerning the importance of early recognition of
stroke, emphasising stroke is a medical emergency.
(Grade C; Level III-3 & IV 39 )
b) <strong>Stroke</strong> patients should be given a high priority
grouping by ambulance services.
(Grade C; Level III-2 83, 84 )
c) Ambulance services should be trained in the use
of validated rapid pre-hospital stroke screening
tools and incorporate such tools into protocols <strong>for</strong>
all pre-hospital assessment of people with
suspected stroke. (Grade B; Level III-2 86-89 )
d) Ambulance services should preferentially transfer
suspected patients to a hospital with stroke unit
care. ( )
3. Early Assessment and Diagnosis
3.1: Assessment of TIA
a) All patients with suspected TIA should have a full
assessment that includes assessment of stroke risk
using the ABCD 2 tool at the initial point of health
care contact whether first seen in primary or
secondary care. (Grade B; Level II 35 )
b) The following investigations should be undertaken
routinely <strong>for</strong> all patients with suspected TIA: full
blood count, electrolytes, renal function, cholesterol
level, glucose level, and electrocardiogram. ( )
c) Patients classified as high risk (ABCD 2 >4) should
have an urgent CT brain (‘urgent’ is considered as
soon as possible, but certainly within 24 hours).
Carotid duplex ultrasound should also be
undertaken urgently in patients with carotid territory
symptoms who would potentially be candidates <strong>for</strong>
carotid re-vascularisation. Patients classified as low
risk (ABCD 2 4) should have a CT brain and carotid
ultrasound (where indicated) as soon as possible
(i.e. within 48-72 hours). (Grade B; Level I
35, 100, 102
& Level III-3 99 )
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Key Message