Table 5 Case scenario 2
True | False | Unsure | Evidence | |
|---|---|---|---|---|
n | n | n | ||
1.As symptoms have resolved there is no urgency in the assessment and management | 2 | 30 | 0 | Although the symptoms have resolved the risk of stroke remains significant. The ABCD2 score for this patient is 7 and would place him at high risk of a subsequent stroke. A score of 6 or 7 was found to have an 8.1 % risk of subsequent stroke in the following 48 hours [21]. |
2.Management in GP setting with CT before starting aspirin | 20 | 9 | 3 | The patient’s score is considered high risk, with the NSF recommending that a CT brain be performed within 24 hours [23]. |
Whilst the use of aspirin after a CT is recommended, a study of 9000 patients randomised to aspirin without CT found no significant excess haemorrhages, even in those who had an initial haemorrhagic stroke [25]. However, in practice CT brain is performed prior to commencing aspirin. | ||||
Admission to an ASU would allow comprehensive monitoring and early access to treatment including thrombolysis if appropriate if this patient were to develop a subsequent stroke but the evidence remains unclear as to the best model of care. | ||||
3.Refer patient to neurology outpatients | 7 | 20 | 4 | |
4. Best practice would be to have him admitted to an Acute Stroke Unit (ASU). | 16 | 7 | 9 |