Saudi Stroke Standards

Protocol for stroke code pathway Purpose a. To ensure standardization of acute stroke patient care b. Have protocols with facilities for transfers to more specialized centers when needed. c. Have facilities for telemedicine when necessary. Rationale  Standardized medical care results in better outcomes and less variability in healthcare provision.  To standardize the acute stroke imaging protocol.  Utilization of tele-stroke allows early and effective clinical assessment and support treatment decision for reperfusion therapy.  Acute stroke management is time dependent, it is useful to provide initial emergency stroke care in ED and initiate the decision for transfer.  Evidence for utilization of tele-stroke is well established in acute stroke management. Standards 1. An acute code stroke pathway will be developed in all hospitals, which will include recognition of acute stroke symptoms, urgent diagnosis, treatment and transfer. 2. Non-contrast CT imaging should be used to determine the decision about acute stroke management. 3. All patients with suspected acute stroke must have con-contrast CAT scan of the brain completed as soon as possible and within 25 minutes maximum on arrival. 4. Patient must have brain imaging obtained and interpreted as soon as possible and within 45 minutes of arrival into the hospital. 5. Brain imaging must support the decision for timely appropriate therapy. The aim of early CT imaging is to shorten the duration for decision of treatment. 6. Brain imaging to exclude ICH is recommended as part of initial evaluation for stroke patients who are potentially eligible for reperfusion therapy. 7. Using tele-stroke is recommended for hospitals with limited in-house expertise for diagnosis and treatment of stroke patients. 8. All hospitals must have a transfer protocol if advanced stroke care is not available. QM