8
Diagnosis
Î For sites without in-house imaging interpretation expertise,
teleradiology systems approved by the Food and Drug Administration
(FDA) (or equivalent organization) are recommended for timely review
of brain computed tomography (CT) and magnetic resonance imaging
(MRI) scans in patients with suspected acute stroke (I-B).
• When implemented within a telestroke network, teleradiolog y systems approved
by the FDA (or equivalent organization) are useful in supporting rapid imaging
interpretation in time for fibrinolysis decision making (I-B).
ÎThe development of comprehensive stroke centers is recommended (I-C).
Î Implementation of telestroke consultation in conjunction with
stroke education and training for healthcare providers can be useful
to increase the use of intravenous (IV) recombinant tissue-type
plasminogen activator (rtPA) at community hospitals without access to
adequate onsite stroke expertise (IIa-B).
Î The creation of acute stroke-ready hospitals can be useful (IIa-C).
Notes: As with primary stroke centers, the organization of such resources will depend
on local resources.
The stroke system design of regional acute stroke-ready hospitals and primary stroke centers
that provide emergency care and that are closely associated with a comprehensive stroke
center, which provides more extensive care, has considerable appeal.
Emergency Evaluation and Diagnosis of Acute Ischemic Stroke
Î An organized protocol for the emergency evaluation of patients with
suspected stroke is recommended (I-B).
Notes: The goal is to complete an evaluation and to begin fibrinolytic treatment
within 60 minutes of the patient's arrival in an emergency department (ED).
Designation of an acute stroke team that includes physicians, nurses, and laboratory/
radiolog y personnel is encouraged.
Patients with stroke should have a careful clinical assessment, including neurological
examination.
Î The use of a stroke rating scale, preferably the National Institutes of
Health Stroke Scale (NIHSS – Table 2), is recommended (I-B).
Î A limited number of hematologic, coagulation, and biochemistry tests
are recommended during the initial emergency evaluation, and only
the assessment of blood glucose must precede the initiation of IV rtPA
(Table 3) (I-B).
Î Baseline electrocardiogram assessment is recommended in patients
presenting with acute ischemic stroke but should not delay initiation
of IV rtPA (I-B).
Î Baseline troponin assessment is recommended in patients
presenting with acute ischemic stroke but should not delay
initiation of IV rtPA (I-C).
