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Stroke and transient ischaemic attack in over 16s: diagnosis and initial management [CG68]

Measuring the use of this guidance

Recommendation: 1.2.4.1

People with stable neurological symptoms from acute non-disabling stroke or TIA who have symptomatic carotid stenosis of 50–99% according to the NASCET (North American Symptomatic Carotid Endarterectomy Trial) criteria, or 70–99% according to the ECST (European Carotid Surgery Trialists' Collaborative Group) criteria, should: - be assessed and referred for carotid endarterectomy within 1 week of onset of stroke or TIA symptoms - undergo surgery within a maximum of 2 weeks of onset of stroke or TIA symptoms - receive best medical treatment (control of blood pressure, antiplatelet agents, cholesterol lowering through diet and drugs, lifestyle advice).

What was measured: Proportion of people that received carotid endarterectomy surgery within 2 weeks of the onset of symptoms.
Data collection end: December 2015
57%
Data collection end: December 2017
59%
Area covered: UK
Source: Royal College of Surgeons. National vascular registry.


Recommendation: 1.3.1.1

All people with suspected stroke should be admitted directly to a specialist acute stroke unit following initial assessment, either from the community or from the A&E department.

What was measured: The proportion of patients directly admitted to a stroke unit within 4 hours of clock start.
Data collection end: March 2017
57.4%
Area covered: Great Britain
Source: Royal College of Physicians. Sentinel Stroke National Audit Programme.


Recommendation: 1.3.2.2

For all people with acute stroke without indications for immediate brain imaging, scanning should be performed as soon as possible.

What was measured: Proportion of applicable stroke patients scanned within 1 hour of clock start.
Data collection end: March 2014
41.9%
Data collection end: March 2015
44.1%
Data collection end: March 2016
47.5%
Data collection end: March 2017
52.6%
Area covered: Great Britain
Source: Royal College of Physicians. Sentinel Stroke National Audit Programme.


Recommendation: 1.4.2.1

All people presenting with acute stroke who have had a diagnosis of primary intracerebral haemorrhage excluded by brain imaging should, as soon as possible but certainly within 24 hours, be given: aspirin 300 mg orally if they are not dysphagic or aspirin 300 mg rectally or by enteral tube if they are dysphagic. Thereafter, aspirin 300 mg should be continued until 2 weeks after the onset of stroke symptoms, at which time definitive long-term antithrombotic treatment should be initiated. People being discharged before 2 weeks can be started on long-term treatment earlier.

What was measured: Proportion of patients with a stroke shown to be non-haemorrhagic, or a history of TIA, who have a record in the preceding 12 months that an anti-platelet agent, or an anti-coagulant is being taken
Data collection end: March 2015
91.7%
Area covered: England
Source: Health and Social Care Information Centre. Quality Outcomes Framework.

What was measured: STIA007: The percentage of patients with a stroke shown to be non-haemorrhagic, or a history of TIA, who have a record in the preceding 12 months that an anti-platelet agent, or an anti-coagulant is being taken.
Data collection end: March 2016
91.8%
Data collection end: March 2017
91.9%
Area covered: National
Source: Health and Social Care Information Centre. Quality and Outcomes Framework.


Recommendation: 1.6.1.1

On admission, people with acute stroke should have their swallowing screened by an appropriately trained healthcare professional before being given any oral food, fluid or medication.

What was measured: Proportion of patients who receive a swallow screen within 4 hours, if applicable
Data collection end: March 2014
63.6%
Data collection end: March 2017
73.8%
Area covered: Great Britain
Source: Royal College of Physicians. Sentinel Stroke National Audit Programme.


Recommendation: 1.6.1.2

If the admission screen indicates problems with swallowing, the person should have a specialist assessment of swallowing, preferably within 24 hours of admission and not more than 72 hours afterwards.

What was measured: Proportion of patients who receive a swallow assessment within 72 hours, if applicable
Data collection end: March 2014
78.3%
Data collection end: March 2017
87%
Area covered: Great Britain
Source: Royal College of Physicians. Sentinel Stroke National Audit Programme.



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