Scottish Intercollegiate Guidelines Network (SIGN)

SIGN 108: Management of patients with stroke or TIA:
Assessment, investigation, immediate management and secondary prevention

BACKGROUND

The guideline on the Management of patients with stroke or TIA: assessment, investigation, immediate management and secondary prevention is published on December 16th 2008. The guideline emphasises the importance of getting patients to specialist stroke services quickly to allow prompt diagnosis and treatment.

A patient version of the guideline is also published..

WHY WE NEED A GUIDELINE

Scotland’s action plan for health and wellbeing “Better Health, Better Care” highlighted stroke as a national clinical priority.

Stroke is the third biggest cause of mortality and the main cause of disability in Scotland. Around 8,500 people experience their first-ever-in-a-lifetime stroke every year in Scotland, with around 70,000 individuals living with stroke and its consequences. Immediate mortality is high and approximately 15% of stroke patients die within 30 days.

Stroke is an age-dependent illness and approximately 80% of people are 65 years of age and over when they have their first stroke.

The predicted increase in this age group in the Scottish population and the greater increase in the older old will be paralleled by a continuing increase in the number of strokes in Scotland.

THE CHALLENGE FOR HEALTHCARE PRACTITIONERS

To achieve urgent assessment of patients with transient ischaemic attack (TIA)
to increase access to thrombolysis, with more patients available for treatment within the 4.5 hour time window for its administration
to ensure patients receive antiplatelet and statin therapy for secondary prevention
to refer suitable patients urgently for carotid assessment and carotid endarterectomy.

REMIT

This guideline provides recommendations based on current evidence for best practice in the management of patients with stroke or TIA.

The guideline follows the patient pathway from the onset of a suspected stroke. It provides recommendations on:

early management of suspected stroke by non- stroke specialist practitioners
clinical and radiological assessment
treatment of patients with ischaemic stroke, TIA or primary intracerebral haemorrhage (PICH)
reducing the risk of recurrence of further stroke by medical and surgical interventions and lifestyle changes
providing information and support tailored to the needs of patients and carers.

Management of patients with subarachnoid haemorrhage has not been addressed.

POTENTIAL USERS

This guideline will be of particular interest to stroke physicians, stroke nurses, specialists in geriatric medicine and care of the elderly, neurologists, neuroradiologists, radiologists, vascular surgeons, cardiologists, general physicians, speech and language therapists, physiotherapists, occupational therapists, pharmacists, specialists in emergency medicine, specialists in intensive care, paramedics, specialists in public health, nurse practitioners and general practitioners.