EARLY MANAGEMENT AND OUTCOME OF ACUTE STROKE IN AUCKLAND

Background: Studies of acute stroke management in stroke units and ter tiary referral hospitals may not accurately reflect practice within th e population. Reliable information on the management of stroke within a population is sparse. Aims: To compare clinical practice in acute st roke management in Auckland with guidelines for the management and tre atment of stroke in other countries; to provide a baseline measure aga inst which future changes in management can be evaluated. Methods: All new stroke events in Auckland residents in 12 months were traced thro ugh multiple case finding sources. For each patient, a record of inves tigations and treatment during the first week of hospital admission wa s kept. Results: One thousand eight hundred and three stroke events (i ncluding subarachnoid haemorrhages) occurred in 1761 patients in one y ear. Twenty-seven per cent of all events were managed outside hospital and 73% of the stroke events were treated in an acute hospital. Of th e 1242 stroke events admitted to an acute hospital in the first week, only 6% were managed on the neurology and neurosurgery ward, 83% were managed by a general physician or geriatrician and 42% had computed to mography (CT). Of 376 validated ischaemic strokes, 44% were treated wi th aspirin and 12% with intravenous heparin. Of the 690 unspecified st rokes (no CT or autopsy), 38% received aspirin and 0.5% heparin. The 2 8 day in-hospital case fatality for all stroke events admitted to an a cute hospital during the first week was 25%. Conclusions: In Auckland, management of acute stroke differed from clinical guidelines in the h igh proportion of patients managed in the community, the low rate of n eurological consultation, and the low frequency of CT scanning. Despit e these deficiencies in management, the 28 day hospital case fatality in Auckland was similar to other comparable studies which had a high p roportion of cases evaluated by a neurologist and CT.