MRCGP Exam Update - The benefits of stroke units

CURRENT SITUATION

- Stroke is the fourth largest cause of death in the UK and the biggest single cause of major disability.

- Each year over 130,000 people in England and Wales have a stroke. Of those, about a third are likely to die and two thirds are likely to make a recovery or be left disabled and needing rehabilitation.

- Eighty per cent of hospitals in England now have stroke units, but the number of beds still needs to double if specialist care is to be provided for all patients.

- Despite an increase in the number of stroke units - driven by targets in the NSF for older people - a third of stroke patients are being cared for on general wards for most of their hospital stay.

- The National Sentinel Audit of Stroke has found that stroke services in the NHS have improved considerably in recent years, but capacity remains inadequate to meet the needs of all patients (BMJ 2004; 329: 426).

WHAT IS THE EVIDENCE?

- Stroke unit care is one of the most powerful interventions available to help stroke patients, even when compared with tissue plasminogen activator (tPA) and aspirin (Cerebrovasc Dis 2005; 20: 239).

- A recent survey of stroke patients found that they were more satisfied with their care if they were looked after on specialist wards (Survey of Patients 2005: Stroke).

- The risk of death for patients who received stroke unit care has been estimated to be approximately 75 per cent that of the risk for those not receiving it (Stroke 2005; 36: 103).

- Introducing an integrated care pathway for acute stroke may improve the quality of documentation and process of care (Age Ageing 2004; 33: 362).

PRIMARY CARE IMPLICATIONS

- Guidelines have been launched by the Royal College of Physicians aiming to help primary care teams deliver effective treatment and secondary prevention to stroke patients. These include the importance of admission to a specialist stroke unit.

- Patients who have had a stroke should be admitted, ideally to a stroke unit, and have a CT scan within 24 hours of admission.

AVAILABLE GUIDELINES

- The Primary Care Concise Guidelines are based on the updated National Clinical Guidelines for Stroke published in July 2004.

USEFUL WEBSITES

www.rcplondon.ac.uk - Royal College of Physicians.

www.stroke.org.uk - The UK Stroke Association.

www.healthcarecommission.org.uk - The report 'Survey of Patients 2005: Stroke'.

- Dr Louise Newson is a GP in the West Midlands and author of "Hot topics for MRCGP and General Practitioners', PasTest 2004

KEY POINTS

- Stroke is the fourth commonest cause of death.

- All patients should be managed in stroke units.

- Stroke units are associated with lower mortality rates.

- Royal College of Physicians guidelines should be used.

- A CT scan should be given within 24 hours of admission.

- Stroke unit capacity remains inadequate.

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