One-hour scan limit for stroke patients

SUSPECTED stroke patients should undergo a brain scan within one hour of being admitted to hospital, according to new guidance from the Royal College of Physicians.

The timescale is a dramatic reduction on the previous recommended limit of 12 hours and is designed to help identify the cause of a stroke and to ensure patients receive the best treatment as quickly as possible.

Produced by the RCP’s Stroke Programme, the new advice forms part of the fifth edition of the National Clinical Guideline for Stroke – the standard for stroke care in the UK. It is the first guideline to be published online only, offering free access to all clinicians.

The guideline recommends that all acute stroke hospitals have access to brain scans 24 hours a day. It says services must be organised in a way that minimises 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.”

The RCP believes the changes will help more people receive so-called “clot-busting” treatments for acute stroke. These are designed to reopen the blocked artery in the brain and can reduce long-term disability for patients as well as NHS care costs.

The guidance promotes more widespread use of “early supported discharge” as a means of reducing costs. Greater emphasis is placed on the early rehabilitation of stroke patients in their own homes rather than in hospital, with a more multidisciplinary approach to recovery and longer-term rehabilitation.

It 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.”

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