Stroke and TIA – initial management

23rd July 2019 by Louise Hudman

Stroke and TIA – initial management

This is an updated guideline from NICE on the management of stroke and TIA in over 16s. It was first published in 2008 and this update is from May 19.

The most important change for us in this guideline is that they recommend that all patients with a suspected TIA now be seen by a specialist within 24hrs. We should no longer use the ABCD tool to assess risk.

Most of us are used to using the ABCD tool to stratify patient risk after a suspected TIA. Those deemed to be high risk are seen quickly and those at lower risk are seen within 7d. So why should we no longer use the ABCD tool? Evidence suggests that the ABCD tool is not good at predicting those who go onto have stroke. If everyone is seen with 24 hrs, it both improves outcomes and saves money (by reducing the number of people going onto have strokes).  The expectation is that TIA clinics will now run 7 days a week.

Are there any other changes in this guideline?

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