Identifying Symptoms Of Strokes Early And Treating Them
The definitions of a stroke are rapidly developing signs of vocal disturbance of cerebral function lasting more than 24 hours all leading to death with no apparent cause other than vascular origin.
In other patients they will show stroke symptoms and signs that resolve within 24 hours. This is not a stroke but a transient ischaemic attack.
Strokes account for 53,000 deaths in England a year (11% of the total number of deaths).
110,000 people per annum have a stroke and 20,000 have a transient ischaemic attack.
75% of people who suffer a stroke are over the age of 65. One-third die, one-third recover and one-third are left with a disability.
900,000 people are living with the effects of a stroke in England and 50% are dependent upon someone else. The cost to the economy is £7 billion and £2.8 billion to the National Health Service.
There are national clinical guidelines for strokes which have been approved by the National Institute for Health and Clinical Excellence and were published in July 2008. These are key standards and as they have now been in force for almost two years, all Trusts should be following those guidelines.
People admitted to an emergency department with a suspected stroke or TIA should have a diagnosis established rapidly. The diagnosis should always be reviewed by an experienced clinician with an expertise in strokes.
It is absolutely essential once a stroke is suspected that brain imaging is undertaken immediately and within one hour as a worse case scenario. A decision will then be made as to whether the patient can be treated with thrombolysis.
This should be administered only within a well organised stroke service with staff trained in delivering thrombolysis and in monitoring any complications. Also the stroke unit must have immediate access to imaging and re-imaging with staff trained to interpret those images. Thrombolysis drugs are licensed for 3 years from the onset of a stroke. They will be given if there is a definite acute stroke and there is a clear time as to the onset of symptoms. Also presentation to the emergency department should be within 3 hours of this acute onset.
Furthermore, to be given this treatment a haemorrhage must be excluded by a CT scan and the patient must be aged 18 – 80 years old. The risk factors are severe bleeding or death.
A survey was conducted into hospitals in terms of their safety in managing stroke patients. Unfortunately, 10 Trusts admitted that they scanned less than 40% of their patients within 24 hours and 17 Trusts were unable to provide any data at all.
The National Institute of Clinical Excellence Guidelines (NICE) state that all patients with a suspected stroke after initial assessment in the emergency department should be admitted to a specialist stroke unit. In reality, only 25% are admitted to a stroke unit which means that the remaining 75% are more likely to die and more likely to leave hospital dependent on a carer.
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