Life after stroke. New Zealand guideline for management of stroke.
Life after stroke. New Zealand guideline for management of stroke.
29 October 2008
New Zealand Guidelines Group - Private Nonprofit Organization
Stroke Foundation of New Zealand, Inc. - Medical Specialty Society
Summary,
GUIDELINE OBJECTIVE(S)
* To facilitate better and more equitable outcomes for people with a stroke in New Zealand and their families/whanau by presenting the evidence currently available for the most effective management of specific problems after stroke
* To add to an existing knowledge base for evidence-based, cost-effective, and equitable management of stroke
* To provide a commentary on the most effective way to manage stroke in the New Zealand setting, including approaches to cultural issues
* To assist people with a stroke and their families/whanau to make informed decisions
* To highlight the need for significant changes in current practice in New Zealand
* To ensure access to resources for stroke management
TARGET POPULATION
Adult patients in New Zealand who have had a stroke and their care providers
Note: This guideline does not cover stroke in infants, children, and youth.
INTERVENTIONS AND PRACTICES CONSIDERED
Note: This guideline does not cover primary prevention of stroke.
Diagnosis
1. Imaging of the brain
* Computed tomography
* Magnetic resonance imaging
* Other studies as indicated (e.g., ultrasound)
2. Blood glucose electrocardiogram
3. Chest x-rays (considered but not recommended)
4. Assays:
* Full blood count (including platelet count)
* Erythrocyte sedimentation rate
* Serum urea
* Creatinine
* Electrolytes
5. Coagulation studies:
* Bleeding time
* Prothrombin times
* Activated thromboplastin times
Treatment/Management
1. Organized stroke services
* Multidisciplinary team
* Use of written protocols
* Services responsive to needs of very young, very old, and specific groups such as Maori and Pacific peoples.
2. Initial assessments
* Use of validated, reliable instruments
* Swallowing assessment
* Assessment for vascular risk factors
* Rehabilitation assessment
3. Nutrition
* Nutrition support
* Diet modification
* Feeding posture and equipment
4. Endovascular treatment (considered but not specifically recommended)
5. Osmotherapy and hyperventilation for selected patients
6. Drainage of cerebrospinal fluid
7. Surgical decompression
8. Carotid endarterectomy
9. Compression stockings
10. Early mobilization
11. Supplemental oxygen
12. Carotid angioplasty and stenting
13. Angiography for selected patients
14. Surgical removal of haematoma
15. Rehabilitation services and follow up
* Early supported discharge
* Patient and care giver education
16. Drug treatments considered:
* Oral hypoglycaemics
* Anticonvulsants
* Insulin
* Aspirin
* Tissue plasminogen activator (tPA)
* Intravenous streptokinase or ancrod
* Heparin
* Corticosteroids
* Antihypertensive agents
* Statins
* Clopidogrel
* Dipyridamole
* Warfarin
17. Alternative therapies
MAJOR OUTCOMES CONSIDERED
* Effectiveness of medication
* Return to previous level of function (e.g., activities of daily living, leisure activities, ability to drive)
* Patient satisfaction/quality of life
New Zealand Guidelines Group - Private Nonprofit Organization
Stroke Foundation of New Zealand, Inc. - Medical Specialty Society
Summary,
GUIDELINE OBJECTIVE(S)* To facilitate better and more equitable outcomes for people with a stroke in New Zealand and their families/whanau by presenting the evidence currently available for the most effective management of specific problems after stroke
* To add to an existing knowledge base for evidence-based, cost-effective, and equitable management of stroke
* To provide a commentary on the most effective way to manage stroke in the New Zealand setting, including approaches to cultural issues
* To assist people with a stroke and their families/whanau to make informed decisions
* To highlight the need for significant changes in current practice in New Zealand
* To ensure access to resources for stroke management
TARGET POPULATION
Adult patients in New Zealand who have had a stroke and their care providers
Note: This guideline does not cover stroke in infants, children, and youth.
INTERVENTIONS AND PRACTICES CONSIDERED
Note: This guideline does not cover primary prevention of stroke.
Diagnosis
1. Imaging of the brain
* Computed tomography
* Magnetic resonance imaging
* Other studies as indicated (e.g., ultrasound)
2. Blood glucose electrocardiogram
3. Chest x-rays (considered but not recommended)
4. Assays:
* Full blood count (including platelet count)
* Erythrocyte sedimentation rate
* Serum urea
* Creatinine
* Electrolytes
5. Coagulation studies:
* Bleeding time
* Prothrombin times
* Activated thromboplastin times
Treatment/Management
1. Organized stroke services
* Multidisciplinary team
* Use of written protocols
* Services responsive to needs of very young, very old, and specific groups such as Maori and Pacific peoples.
2. Initial assessments
* Use of validated, reliable instruments
* Swallowing assessment
* Assessment for vascular risk factors
* Rehabilitation assessment
3. Nutrition
* Nutrition support
* Diet modification
* Feeding posture and equipment
4. Endovascular treatment (considered but not specifically recommended)
5. Osmotherapy and hyperventilation for selected patients
6. Drainage of cerebrospinal fluid
7. Surgical decompression
8. Carotid endarterectomy
9. Compression stockings
10. Early mobilization
11. Supplemental oxygen
12. Carotid angioplasty and stenting
13. Angiography for selected patients
14. Surgical removal of haematoma
15. Rehabilitation services and follow up
* Early supported discharge
* Patient and care giver education
16. Drug treatments considered:
* Oral hypoglycaemics
* Anticonvulsants
* Insulin
* Aspirin
* Tissue plasminogen activator (tPA)
* Intravenous streptokinase or ancrod
* Heparin
* Corticosteroids
* Antihypertensive agents
* Statins
* Clopidogrel
* Dipyridamole
* Warfarin
17. Alternative therapies
MAJOR OUTCOMES CONSIDERED
* Effectiveness of medication
* Return to previous level of function (e.g., activities of daily living, leisure activities, ability to drive)
* Patient satisfaction/quality of life
