Stroke: Towards Better Management: Summary and Recommendations of a Report of the Royal College of Physicians

All doctors, and most of their patients, are familiar with the consequences of stroke. In 1985 more than 70,000 men and women over the age of 65 died after a stroke and only one third of the survivors of stroke made a good recovery. It is thus a major source of chronic disability, placing a very heavy burden on patients' relatives and friends and consuming a great deal of NHS resources. The purpose of this Report is to set out guidelines for the clinical, radiological and pathological assessment of stroke, to suggest how to care for and rehabilitate patients who have suffered a stroke, and to evaluate and recommend measures for its prevention. The Report emphasises the need to use standard terms for the clinical description and classification of stroke, and the assessment of degrees of disability. It traces its changing epidemiology in the UK and in other countries and assesses the significance of putative risk factors such as hypertension, smoking, obesity, alcohol, diabetes, serum cholesterol, oral contraceptives and ischaemic heart disease. It sets out the indications for admitting patients to hospital and how they should be investigated, including the value of CT scanning at different intervals after the stroke has occurred. The Report describes the organisational aspects of the care of stroke patients during the acute phase, in the early recovery phase and in the longer term rehabilitation. The ideal requirements include a small but committed multidisciplinary stroke care team, with an awareness of psychological problems that may occur after a stroke; a rehabilitation ward for patients in the recovery phase may also be of value, but this has not yet been fully assesssd. The Report is concerned that there is a dearth of medical staff adequately trained in the medical aspects of long-term disability and makes recommendation for their training as well as that of nurses.