Stroke,Past,Present, Future

Impact of stroke1,2

• Stroke has a major impact on people’s lives

• Stroke is the:– single most devastating effect of hypertension

– third most common cause of death

– largest single cause of severe disability

• The estimated annual cost of stroke to the NHS is over £2.3 billion

ACUTE STROKE UNIT

• OCTOBER 1 2006

• WARDS REARRANGED JUN-AUG 2006

• ASU REVAMPED SEPT 06

• NURSING STAFF RECRUITED SEPT O6

• 2ND CONSULTANT X SEPT 06

IMPACT

• CLOT-BUSTING OCT 06

• ALL STROKE PATIENTS SEEN BY ACUTE STROKE TEAM ON ADMISSION

• ALL PATIENTS SCANNED ON ADMISSION

0no disability

100%80%60%40%20%0%

Active

Placebo

1No significant disability

2-3Slight or moderate disability

4-5 or dead

Modified Rankin Scale at Day 90:

general shift to the left

NXY-059:mRS at day 90

Common odds ratio for improvement 1.20 (95% CI 1.01-1.42)

IGNORANCE

• Lancet 2001;358:683-4

• Thrombolysis CCU 30 per 1000

• Thrombolysis ASU 140 per 1000

• Aspirin 12 per 1000

• ASU 66 per 1000

RESULTS

• SOUTHEND 228 / 246

• BOTTOM 15% for last 8 years

• No improvement in 4 years

• 0% for ASU

• 14% OT ASSESSMENT

• 21% AGREED REHAB GOALS

• 18% MOOD ASSESSED

COMMUNITY

• INTERMEDIATE CARE UNITS

• NURSING HOMES

• GENERAL PRACTICE AND STROKE

• WHEELCHAIR SCANDAL

• DEFICIENT PHYSIO AND OT FOLLOW-UP

WHAT DO WE NEED

• MONEY

• STAFF

• POLITICAL SUPPORT

• PUBLIC HEALTH INFORMATION

• PCT PROTOCOL FOR STROKE

• VOLUNTEERS

• PFI