Management of stroke in Auckland Hospital in 1996

Aims. To review the management of stroke in Auckland Hospital; compare curr ent management with practice in Auckland in 1991/92; and determine how many patients may be suitable for treatment with aspirin or tissue plasminogen activator (t-PA). Methods. Retrospective review of case notes for all patients over the age o f 15 years presenting during four months in 1996 with symptoms and signs of an acute stroke. Subarachnoid haemorrhages were excluded. Results. There were 184 stroke events (135 ischaemic strokes, 26 intracereb ral haemorrhages, 23 unspecified strokes) in 179 patients. The time between the onset of symptoms and arrival in hospital was available for 109 patien ts: the overall median time was three hours, two hours for intracerebral ha emorrhages, three hours for ischaemic strokes, four hours for unspecified s trokes. Most patients (78%) were admitted to a general medical ward. Only 1 0% of the patients managed on a non-neurological ward were referred to a ne urologist. Computed tomography (CT) was obtained in 88% of the patients. Th e median time from the onset of symptoms to CT was 19 hours (11 hours for i ntracerebral haemorrhages, 21 hours for ischaemic strokes). Only 11 patient s (10%) were scanned within three hours of the onset of symptoms. Of the 13 5 patients who had an ischaemic stroke, 36% were treated with aspirin and 6 % with heparin in the first 48 hours. Thirty-two patients (17%) died in hos pital, 81 (47%) returned home, 37 (20%) were transferred to a rest home or private hospital and 28 (15%) were transferred to other places. Conclusions. Compared with 1991, the rate of CT scanning after a stroke inc reased from 42% to 88%. At present, no more than 5% of all patients present ing with a stroke are suitable for consideration of treatment with t-PA. Ro utine treatment with aspirin in the first 48 hours could be achieved withou t other major changes in management.