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

Measuring the use of this guidance

Recommendation: 1.2.1.2

People who have had a suspected TIA who are at high risk of stroke (for example an ABCD2 score of 4 or above or with crescendo TIA) in whom the vascular territory or pathology is uncertain[11] should undergo urgent brain imaging[12] (preferably diffusion-weighted MRI [magnetic resonance imaging]).

What was measured: Patients with ABCD>4 who had imaging performed at the time of clinic attendance

71.4%

Area covered:	Local
Source:	Das RT. (2013) Fast-track TIA clinic-An effective model for providing TIA intervention. International Journal of Stroke, Vol 8 suppl 3 p65

Recommendation: 1.2.3.1

All people with suspected non-disabling stroke or TIA who after specialist assessment are considered as candidates for carotid endarterectomy should have carotid imaging within 1 week of onset of symptoms. People who present more than 1 week after their last symptom of TIA has resolved should be managed using the lower-risk pathway.

What was measured: High risk patients who receive imaging within 24 hours

96%

Area covered:	Local
Source:	Guyler PCL (2013) Redesign of the transient ischaemic attack (TIA) clinic-a multi-disciplinary initiative to create a seven-day patient-centred district general hospital service. International Journal of Stroke, Vol 8 suppl 3 p63

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: Patients referred for surgery within 2 days of symptoms

Data collection end: September 2009

18.1%

Number that met the criteria: 646 / 3564

Data collection end: September 2010

25.8%

Number that met the criteria: 904 / 3501

Area covered:	National
Source:	Carotid Interventions Audit

What was measured: Patients referred for surgery within 14 days of symptoms that triggered referral

Data collection end: September 2009

33%

Number that met the criteria: 1005 / 3044

Data collection end: September 2010

39.7%

Number that met the criteria: 1420 / 3577

Data collection end: September 2011

48.8%

Number that met the criteria: 2047 / 4194

Area covered:	National
Source:	Carotid Interventions Audit

What was measured: Patients referred for surgery within 2 days of symptom

Data collection end: September 2011

32.6%

Number that met the criteria: 1341 / 4112

Area covered:	National
Source:	Carotid Interventions Audit

What was measured: Patients, across the whole study period, who waited more than 2 weeks from symptom onset to surgery

Data collection end: September 2010

30%

Number that met the criteria: 652 / 2174

Area covered:	Multi-region
Source:	Purkayastha D, et al (2012) Delayed Carotid Surgery: what are the Causes in the North West of England. European Journal of Vascular and Endovascular Surgery. Vol 43 pp637-641

What was measured: Patients referred for surgery within 14 days of symptom that triggered referral

Data collection end: September 2012

55.9%

Number that met the criteria: 2471 / 4419

Area covered:	National
Source:	Carotid Interventions Audit

What was measured: Patients referred for surgery within 7 days of onset of symptoms

Data collection end: September 2012

69.5%

Number that met the criteria: 3018 / 4342

Area covered:	National
Source:	Carotid Interventions Audit

What was measured: Patients who had endarterectomy within 7 days of the index event

89%

Area covered:	Local
Source:	Guyler PCL (2013) Redesign of the transient ischaemic attack (TIA) clinic-a multi-disciplinary initiative to create a seven-day patient-centred district general hospital service. International Journal of Stroke, Vol 8 suppl 3 p63

What was measured: Proportion of people that received carotid endarterectomy surgery within 2 weeks of the onset of symptoms.

Data collection end: December 2009

37%

Data collection end: December 2012

56%

Data collection end: December 2015

57%

Area covered:	UK
Source:	Royal College of Surgeons. National vascular registry.

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: July 2015

91.7%

Area covered:	England
Source:	Health and Social Care Information Centre. Quality Outcomes Framework.

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