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Do patients presenting with Stroke get timely and appropriate investigations?
Poster Title: Do patients presenting with Stroke get timely and appropriate investigations?
Submitted on 25 Sep 2019
Author(s): Mac a' Bháird K, Nawaz GD, Cameron CM, McManus J, Hunter MA
Affiliations: RAH Paisley, NHS Greater Glasgow and Clyde. University of Glasgow
Poster Views: 1,158
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Poster Information
Abstract: Background: Stroke is the 4th leading cause of death in the UK with more than 100,000 new cases each year. We assessed our performance in imaging patients presenting with Stroke with reference to national guidelines.

Method: We reviewed imaging performed for all patients presenting to Emergency/Admissions Units over 2 months to assess for ischaemia on CT/MRI, and stenosis/occlusion on US and CTA.

Results: 106/107 (98%) patients with acute Stroke/TIA had CT immediately on admission. The other patient underwent MRI within 24 hours.

16/40 (40%) patients with anterior circulation stroke had US within 48 hours. 20 (50%) were performed after 48 hours. 4 not performed (10%).

16 CTAs were performed, 4 (25%) within 48 hours, 12 (75%) after.

3 patients with posterior circulation symptoms underwent US.

Discussion: Our immediate imaging of patients presenting with acute Stroke is nearing the standard. Our management of carotid imaging is less satisfactory, with >50% of Duplex US/CTAs performed more than 48 hours after presentation. 3 patients underwent unnecessary examinations.
The results were discussed at our stroke MDT. Accurate clinical history/examination in determining anterior/posterior circulation lesion, imaging referral from stroke clinicians, and appropriate vetting of requests are targets for improvement. Education of referring clinicians and Radiology department should improve compliance. We plan to reaudit to assess how our intervention has altered practice.
Summary: We used national guidelines to audit the timing and appropriateness of imaging in patients presenting to our centre with clinical signs and symptoms of stroke. In particular, we assessed the time taken to undergo initial CT brain scan, the proportion who underwent subsequent MRI brain, and the timing and appropriateness of further cerebrovascular imaging, including carotid Doppler Ultrasound and CT angiography (CTA).References:
1. SIGN Guideline 108 - Management of patients with stroke or TIA. Date accessed: September 2018
2. Smajlović D, Sinanović O. Sensitivity of the neuroimaging techniques in ischemic stroke. Med Arh. 2004;58(5):282-4
3. NICE Guideline 128 - Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. Date accessed: May 2019
4. The Stroke Association “State of the Nation Report”

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