Clinical Management of Acute Stroke: The Acute Stroke Clinical Care Standard
Published: 21 February 2021
Published: 21 February 2021
In 2017, there were about 38,000 stroke events in Australia. That’s more than 100 strokes every day (AIHW 2020).
Stroke is a leading cause of disability and accounts for about 5.3% of deaths in Australia, making it one of the five most common underlying causes of mortality (ACSQHC 2019; AIHW 2020).
Stroke is a medical emergency. Surviving and recovering from a stroke is reliant on rapid recognition and treatment, as there is only a narrow window of time during which interventions will work effectively (ACSQHC 2019).
Despite this, data from 2015 found that only 34% of stroke patients presented to hospital within three hours of symptom onset (ACSQHC 2019).
While stroke care in Australia has been improving, there are still issues that need to be addressed. The Acute Stroke Clinical Care Standard aims to facilitate continuous improvement and ensure patients receive the most effective care possible (ACSQHC 2019).
There are both modifiable (able to be changed) and non-modifiable (unable to be changed) risk factors for stroke.
Modifiable risk factors include:
Non-modifiable risk factors include:
While the death rate of stroke is decreasing in Australia, there are other issues related to stroke care in Australia:
Reperfusion treatments are used to treat ischaemic stroke by restoring blood flow and oxygen supply to the area of the brain affected by the blockage. Reperfusion treatments include:
(ACSQHC 2019; Stroke Foundation 2017; Better Safer Care 2019)
In 2019, the Australia Commission on Safety and Quality in Health Care released the Acute Stroke Clinical Care Standard. This standard aims to improve stroke care in Australia, with a goal of:
The standard contains seven quality statements related to the recognition, assessment and management of acute stroke:
Patients experiencing a suspected stroke should be assessed immediately using a validated screening tool. An example is the F.A.S.T. (Face, Arm, Speech and Time) test:
|F - Face||Has the patient’s mouth drooped?|
|A - Arm||Is the patient able to lift both arms?|
|S - Speech||Is the patient’s speech slurred? Can they understand you?|
|T - Time||Call 000 immediately if the patient is displaying any of the above signs.|
Other screening tools include:
Other potential symptoms of stroke include:
Be aware that the symptoms of stroke may mimic:
(Ambulance Victoria 2019)
Patients experiencing suspected ischaemic stroke are offered reperfusion treatment as soon as possible if:
When considering reperfusion, the following factors should be taken into account:
Reperfusion treatment is time-critical (ACSQHC 2019). It is therefore essential to note the time of symptom onset (Ambulance Victoria 2019). Refer to Chapter 3 of the Clinical Guidelines for Stroke Management for specific treatment timeframes.
Patients experiencing stroke should be treated in a specialised stroke unit by an interprofessional team. This may comprise:
Ideally, patients should be admitted to the unit within three hours of symptom onset (ACSQHC 2019).
Patients’ individual rehabilitation needs should be assessed within 24 to 48 hours of hospital admission. This assessment should be performed using an assessment tool such as the Australian Stroke Coalition’s Assessment for Rehabilitation: Pathway and Decision-Making Tool (ACSQHC 2019).
Assessment should help determine when discharge is appropriate and whether the patient needs to be referred onwards (ACSQHC 2019).
Patient rehabilitation should be commenced during acute care, when clinically appropriate. Avoid intensive mobilisation within 24 hours of stroke onset (ACSQHC 2019).
It is estimated that 40% of people who have had a stroke will go on to experience another within the next 10 years, with the first year after a stroke being the most high-risk timeframe. However, over 80% of strokes are preventable (Stroke Foundation 2018; Ausmed 2020).
Patients should be advised on how to reduce modifiable risk factors. This may involve:
(Stroke Foundation 2017)
Patients may also be prescribed medicines such as antihypertensives, antithrombotics or lipid-modifying therapy (ACSQHC 2019).
Refer to Chapter 4 of the Clinical Guidelines for Stroke Management for a comprehensive overview of medicines and treatments for secondary prevention.
Carers should receive education and practical training on how to care for patients who have experienced a stroke. This may comprise:
Carers should also be given contact information for relevant support services prior to patient discharge (ACSQHC 2019).
Prior to discharge, patients who have experienced a stroke should work with clinicians to develop an individualised care plan containing:
Within 48 hours of discharge, a copy of this plan should be forwarded to the patient and their general practitioner or ongoing clinical provider (ACSQHC 2019).
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