The shocking state of UK stroke services is highlighted in an Editorial in this week's Lancet. The Editorial refers to a recent report by the Clinical Effectiveness and Evaluation Unit of the Royal College of Physicians, London, which showed as many as a quarter of stroke patients do not receive the best treatment in a specialist stroke unit.
Good stroke management is considered to comprise the following: 90% of stay in a stroke unit, rapid screening for swallowing difficulties, a brain scan within 24 h, aspirin, assessment by a physiotherapist and an occupational therapist, being weighed, mood assessment, and rehabilitation goals agreed by a multidisciplinary team. Rapid initial assessment, clot-busting drugs when appropriate, and rehabilitation are essential to aid recovery. But the report showed that only 17% of the total sample was admitted to an acute stroke unit within 4 h of hospital admission. As few as 21% had a brain scan within 3 h. And although an estimated 15% of patients were eligible for thrombolysis, only 1% received it.
The Editorial says: "These are shocking findings. Stroke services in England, Wales, and Northern Ireland are offering not only unequal care, but also care that falls below the standards set out in the National Stroke Strategy." It adds, however, that the strategy has stimulated improvement in stroke care and things are better now than they were in 2006.
While money and resources such as inadequate staffing are clearly a problem, the Editorial also advocates higher priority for stroke care and increased public awareness. A successful advertising campaign in the US, using the slogan 'time is brain', showed the importance of early recognition of stroke symptoms. A similar campaign is underway in the UK. The Editorial says: "Increased use of FAST (one or more of facial weakness, arm and leg weakness, speech problems, then time to call an emergency ambulance) to diagnose stroke and therefore take patients directly to an acute stroke unit would enable rapid admission to the appropriate place... Increasing the priority with which ambulances respond to calls for suspected stroke would also help."
It concludes: "Stroke is a medical emergency. Despite almost two decades of research that has proven the benefits of stroke units, thrombolysis, and aspirin in reducing mortality and disability, stroke still lies in the shadow of its big sister, heart attack... Yet stroke-related disability is expected to substantially increase as populations age. In view of the worldwide shortage of health-care professionals and other resources to implement the strategies that work for stroke care, never has 'time is brain' seemed more appropriate."
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For full Editorial, see: http://press.thelancet.com/editorials0205.pdf
Journal
The Lancet