Key priorities for implementation

Key priorities for implementation

Rapid recognition of symptoms and diagnosis

  • In people with sudden onset of neurological symptoms a validated tool, such as FAST (Face Arm Speech Test), should be used outside hospital to screen for a diagnosis of stroke or TIA.

  • People who have had a suspected TIA who are at high risk of stroke (that is, with an ABCD2 score of 4 or above) should have:

    • aspirin (300 mg daily) started immediately

    • specialist assessment[6] 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.

  • People with crescendo TIA (two or more TIAs in a week) should be treated as being at high risk of stroke, even though they may have an ABCD2 score of 3 or below.

Specialist care for people with acute stroke

  • All people with suspected stroke should be admitted directly to a specialist acute stroke unit[7] following initial assessment, either from the community or from the A&E department.

  • Brain imaging should be performed immediately[8] for people with acute stroke if any of the following apply:

    • indications for thrombolysis or early anticoagulation treatment

    • on anticoagulant treatment

    • a known bleeding tendency

    • a depressed level of consciousness (Glasgow Coma Score below 13)

    • unexplained progressive or fluctuating symptoms

    • papilloedema, neck stiffness or fever

    • severe headache at onset of stroke symptoms.

Nutrition and hydration

  • 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.



[6] Specialist assessment includes exclusion of stroke mimics, identification of vascular treatment, identification of likely causes, and appropriate investigation and treatment.

[7] An acute stroke unit is a discrete area in the hospital that is staffed by a specialist stroke multidisciplinary team. It has access to equipment for monitoring and rehabilitating patients. Regular multidisciplinary team meetings occur for goal setting.

[8] The GDG felt that 'immediately' is defined as 'ideally the next slot and definitely within 1 hour, whichever is sooner', in line with the National Stroke Strategy.

  • National Institute for Health and Care Excellence (NICE)