NICE Guidance 2019
1.1 Rapid recognition of symptoms and diagnosis
Prompt recognition of symptoms of stroke and transient ischaemic attack
1.1.1 Use a validated tool, such as FAST (Face Arm Speech Test), outside hospital to screen people with sudden onset of neurological symptoms for a diagnosis of stroke or transient ischaemic attack (TIA).
1.1.2 Exclude hypoglycaemia in people with sudden onset of neurological symptoms as the cause of these symptoms.
1.1.3 For people who are admitted to the emergency department with a suspected stroke or TIA, establish the diagnosis rapidly using a validated tool, such as ROSIER (Recognition of Stroke in the Emergency Room).
Initial management of suspected and confirmed TIA
1.1.4 Offer aspirin (300 mg daily), unless contraindicated, to people who have had a suspected TIA, to be started immediately.
1.1.5 Refer immediately people who have had a suspected TIA for specialist assessment and investigation, to be seen within 24 hours of onset of symptoms.
1.1.6 Do not use scoring systems, such as ABCD2, to assess risk of subsequent stroke or to inform urgency of referral for people who have had a suspected or confirmed TIA.
1.1. Offer secondary prevention, in addition to aspirin, as soon as possible after the diagnosis of TIA is confirmed.
Referrals should be made using the following form (blank and EMIS versions downloadable – see right)
Referrals for TIA should be made by email – appointments are available within 24 hours
Coventry & Rugby CCG GP:email firstname.lastname@example.org
South Warwickshire CCG GP: email email@example.com
North Warwickshire CCG GP: email Geh.firstname.lastname@example.org
IF THE PATIENT HAS HAD MORE THAN ONE TIA EPISODE IN THE LAST WEEK – REFER TO ED OR DISCUSS WITH THE STROKE / MEDICAL TEAM URGENTLY
Assessment of Stroke
If suspected arrange 999 hospital admission.
The para-medics will alert the Emergency Department at UHCW, then the stroke team will be available to treat the patient on arrival.
F is for Facial weakness (can the person smile? has their mouth or eye drooped?)
A is for Arm weakness (can the person raise both arms?)
S is for Speech problems (can the person speak clearly and understand what you say?)
T is for Time to call 999 (stroke is a medical emergency)