Rapid intervention can save lives - says guideline for acute stroke

‘RAPID INTERVENTION CAN SAVE LIVES’ SAYS GUIDELINE FOR ACUTE STROKE

UPDATED STANDARDS HIGHLIGHT IMPORTANCE OF EARLY SCANNING

An updated guideline and set of standards published today (Tuesday) emphasise that rapid intervention for stroke patients is the key to saving lives and aiding recovery. The guideline from the Scottish Intercollegiate Guidelines Network (SIGN), and standards from NHS Quality Improvement Scotland (NHS QIS), amount to a revised blueprint for a national package of care for patients with stroke, that builds on existing work taking place at a national level.

The guideline follows the patient from the onset of a suspected stroke, covering management of suspected stroke by non-stroke specialist practitioners, clinical and radiological assessment and treatment of stroke. There is also a section addressing the information and support needs of patients and carers, and a version of the guideline for patients and carers has been produced.

Key aspects of the updated guideline and standards are as follows:

Emergency medical services should be redesigned to facilitate rapid access to specialist stroke services
Patients with suspected ischaemic stroke, who are considered suitable, should be treated with intravenous rt-PA within four and a half hours of definite onset of symptoms
80% of stroke patients have CT/MRI imaging on day of admission, unless there is a contraindication
Stroke patients requiring admission to hospital should be admitted to a stroke unit staffed by a co-ordinated multidisciplinary team with a special interest in stroke care
All patients who have had an ischaemic stroke should receive antiplatelet and statin therapy for secondary prevention of vascular events
All patients with non-disabling acute stroke syndrome/TIA in the carotid territory who are potential candidates for carotid surgery should have carotid imaging
All patients with carotid artery territory stroke without severe disability or transient ischaemic attack should be considered for carotid endarterectomy as soon as possible ideally within two weeks of event.

The guideline focuses on the following areas:

Management of suspected stroke
Hospital care
Prevention recurrence of stroke
Carotid intervention
The provision of information to patients and carers.

Dr Paul Syme, Consultant Physician at Borders General Hospital in Melrose, and chair of the guideline development group, said: “This updated guideline and set of standards emphasise the importance of early recognition, diagnosis and treatment. The guideline and standards will be challenging for NHSScotland to implement, but they comprise the best pathway of care for patients with stroke and will help to save lives and aid recovery.”

Chest, Heart & Stroke Scotland (CHSS) was involved in producing the guideline. The charity’s Chief Executive David Clark said: “In Scotland, we have reduced death rates from stroke by 45% over the last 10 years, partly due to improved treatment in dedicated stroke units, partly due to lifestyle changes. We very much welcome the updated guideline and standards, but we must make sure that the resources are made available to provide these new treatments, and that the guidelines are put into practice so that all potential Scottish stroke patients benefit. We also need to improve awareness about the signs and symptoms of a stroke and to drive home the message that stroke is a medical emergency – we are already working with the NHS through our FAST campaign to achieve this.”

Editors Note:

A stroke is caused when the flow of blood to the brain is stopped by either a blocked blood vessel (ischaemic stroke) or a burst blood vessel causing a bleed (haemorrhage) into the brain. As a result, brain cells do not receive the oxygen and nutrients they need to work normally. Some brain cells become damaged and others die. It is not always possible to know what caused a stroke. Every stroke is different. The symptoms depend on the area of the brain that is affected and how much damage there is.
Stroke is the third biggest cause of mortality and the main cause of disability in Scotland. The Scottish Borders Stroke study measured the community based crude incidence of first-ever-in-a-lifetime stroke (FES) in Scotland at 2.8/1,000 of the population. Around 8,500 FESs occur per annum in Scotland, with around 130,000 in the UK. Stroke is an age-dependent illness and approximately 80% of people with FES present at 65 years of age and over. The predicted increase in this proportion of the Scottish population and the greater increase in the older old (over 80 years), will be paralleled by a continuing increase in the number of strokes in Scotland.
SIGN develops national clinical guidelines aimed at reducing variations in clinical practice and in outcomes for patients. Founded in 1993, SIGN became part of the national quality improvement body, NHS Quality Improvement Scotland, on 1 January 2005.
NHS Quality Improvement Scotland has been established to lead in improving the quality of care and treatment delivered by NHSScotland. To do this it sets standards and monitors performance, and provides NHSScotland with advice, guidance and support on effective clinical practice and service improvements.
The SIGN guideline, ‘Management of patients with stroke or TIA: assessment, investigation, immediate management and secondary prevention - A national clinical guideline’, is available from www.sign.ac.uk.
The updated set of standards is available at www.nhshealthquality.org.