Major Recommendations
Note from the National Guideline Clearinghouse (NGC) and the Institute for Clinical Systems Improvement (ICSI): For a description of what has changed since the previous version of this guidance, refer to Summary of Changes Report -- July 2012. In addition, ICSI began its transition to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system as a method of assessing the quality of evidence and writing recommendations.
The recommendations for the diagnosis and initial treatment of ischemic stroke are presented in the form of a table with a list of evidence-based recommendations and three algorithms with 38 components, accompanied by detailed annotations. Algorithms are provided in the original guideline document for: Screening (Ambulatory), Emergency Department in a Stroke-Ready Facility [SRF] Treatment, and Stroke Code. Clinical highlights and selected annotations (numbered to correspond with the algorithm) follow.
Quality of evidence (Low Quality, Moderate Quality, and High Quality) and strength of recommendation (Weak or Strong) definitions are repeated at the end of the "Major Recommendations" field.
Clinical Highlights
Screening (Ambulatory) Algorithm Annotations
Contact may occur with one of several medical system personnel, including primary care physicians, other medical specialty physicians, emergency medical services, nursing staff in a clinic or urgent care setting or even non-medical triage personnel prior to emergency department (ED) evaluation. This contact may be by phone or in person. Potential staff contacts should be educated in the importance of stroke symptom recognition and the appropriate triage. Time is of the essence in the setting of acute cerebral ischemia. Processes should be in place at all points along a continuum to expedite recognition, transport, assessment and definitive reperfusion.
Public awareness messages in the future should focus on the possibility of urgent treatment (tPA) for ischemic stroke in addition to stroke warning signs and risk factors.
Critical information includes detail as to the location, severity, duration of symptoms, and any aggravating or relieving factors. Symptoms that are commonly associated with ischemic stroke or transient ischemic attack (TIA) include:*
*List from American Stroke Association for public education
Link:
National Guideline Clearinghouse | Diagnosis and initial ...