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Prehospital assessment of stroke: time is brain

02 September 2011
Features
02 September 2011
Volume 3 · Issue 9

Abstract

Prehospital identification is a vital initial step in the emergency medical management of stroke. There are several symptom-based screening tests which facilitate the identification of patients following a systematic clinical assessment. Screening also identifies conditions that mimic stroke and may require their own specific treatment. Between stroke recognition and arrival at hospital, there are important observations and treatment responses which will improve the outcome for patients. Rapid symptom identification and transportation to an appropriate unit will increase the probability that patients with ischaemic stroke can receive thrombolysis. The importance of prehospital stroke assessment is likely to increase with the development of future technologies.

Stroke is one of the leading causes of death and severe disability in adults, affecting approximately 150 000 people in the UK every year. The resulting economic burden is very high, estimated at £4 billion a year by the National Audit Office (Saka et al, 2009). Accordingly, stroke care has been recognized as a top priority by the Department of Health (DH). In 2007, the National Stroke Strategy was published and a stroke improvement programme established through regional cardiovascular networks. A key target is for suspected stroke patients to receive appropriate treatment as soon as possible; the emergency services play a crucial role in ensuring this (DH, 2007).

Medical advances in the last decade have seen stroke care go from ‘supportive medical therapy to that of an acute medical emergency’ (Bray et al, 2005). Acute stroke occurs when blood flow to part of the brain is disturbed by a blocked or bleeding artery. The combination of symptoms each patient develops during a stroke will vary depending on the area of the brain that has been affected, but typically this includes a weakness or sensory loss in the patient's face, arm or leg; loss of co-ordination; visual disturbance, and diffculties with speech. Eighty percent of all cases are due to ischaemia, which follows a critical reduction of blood supply to the brain due to a combination of atheromatous arterial narrowing and blood clot. The thrombus may form at a point of exposed atheroma or ‘fatty plaque’ build up within an arterial wall, or from the heart, i.e. cardioembolism.

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