New guidance for the treatment of stroke from the Royal College of Physicians (RCP) calls for all patients to receive an urgent brain scan within 1 hour of being admitted to hospital.
A 1-hour limit for diagnostic assessment, which is a major reduction in the time limit from the previous guidance of 12 hours, is recommended to identify the cause of a stroke and to ensure patients receive the best treatment at the earliest opportunity.
This is according to the latest clinical guideline, published by the RCP’s Stroke Programme on Monday 3 October 2016, which forms part of the fifth edition of the National Clinical Guideline for Stroke – the standard for stroke care in the UK. The new edition of the guideline is the first to be published online only, to enable free access for all clinicians.
The guideline recommends that all acute stroke hospitals have access to brain scans 24 hours a day and calls for local stroke services to be organised to minimise the time to treatment for the maximum number of people, even if this means that some hospitals currently providing acute stroke services hand over treatment to bigger regional centres. These changes will also help more people to receive ‘clot-busting’ treatments for acute stroke designed to reopen the blocked artery in the brain, treatments which reduce long-term disability for patients and care costs for the NHS.
At a time when NHS finances are increasingly stretched, early supported discharge can also save money in the longer term through reduced disability after a stroke.
The guideline also calls for a greater emphasis on the early rehabilitation of stroke patients in their own homes rather than in hospital, and a more multidisciplinary approach to their recovery and longer-term rehabilitation. Research analysed by the RCP's Stroke Programme indicates that early supported discharge with continued access to rehabilitation after leaving hospital can improve the outcome for stroke patients and provides the greatest potential for people to return to living independently after a stroke. At a time when NHS finances are increasingly stretched, early supported discharge can also save money in the longer term through reduced disability after a stroke.
The new guidance also includes:
- advice on new stroke treatments such as clot removal (mechanical thrombectomy) and blood pressure management for an acute brain haemorrhage
- recommendations about the urgent treatment of suspected mini-stroke to improve prevention of a full stroke
- research-based guidance on the early mobilisation of stroke patients
- research-based guidance on the use of multidisciplinary teams to provide personalised care.
Dr Martin James, a stroke physician in Exeter and one of the editors of the new guideline, said:
Stroke is a medical emergency and if outcomes for people with stroke are to be improved we need to minimise time delays in diagnosis and treatment. In recent years stroke care in the UK has improved dramatically. We have collected very good evidence that the earlier someone with a stroke gets specialist treatments then the better their chances of recovery.
We have also learnt just how cost effective treatments like clot-busting thrombolysis in hospital and early rehabilitation at home can be. With the NHS facing ever-increasing pressures on costs and hospital beds, we need to make sure we deliver treatments that help to get people with stroke back home living independently again.
Professor Avril Drummond, chair of the UK Stroke Forum and fellow of the College of Occupational Therapists, commented:
Rehabilitation is again a key area in the new guidelines which extends across the whole patient and carer pathway. We are particularly pleased that, in this edition, there is more recognition of the length of the journey and thus there are recommendations for enhancing life after stroke. The role of the occupational therapist remains central in the multidisciplinary team.
The RCP’s fifth edition of the National Clinical Guideline for Stroke will be available online from Monday 3 October.
National Clinical Guideline for Stroke
The 2016 Stroke Guideline is the fifth edition of the National Clinical Guideline for Stroke produced by the Intercollegiate Stroke Working Party of the Royal College of Physicians of London. It is the first time the guideline has been launched as a free online resource. The editors draw from the evidence base for the treatment of people with stroke and the report reflects advances in treatment since the last edition of the National Clinical Guideline for Stroke was published in 2012.
Stroke is defined as a clinical syndrome, of presumed vascular origin, typified by rapidly developing signs of focal or global disturbance of cerebral functions lasting more than 24 hours or leading to death (World Health Organization, 1978). Stroke affects over 150,000 people in the UK each year and accounts for 11% of all deaths. Over 80,000 people are hospitalised with acute stroke in England and Wales each year, and stroke is the leading cause of adult-onset disability in the UK. The estimated cost of stroke care in the UK is at least £9 billion per year, with £1 in every £20 spent on the NHS going on stroke care (Saka et al, 'Cost of stroke in the United Kingdom', Age and Ageing. 2009 Jan;38(1):27-32. doi: 10.1093/ageing/afn281).