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Friday, July 2, 1999 Published at 02:04 GMT 03:04 UK


Health

Stroke delays increase deaths

Researchers looked at how long it took to get to a ward

Stroke patients are more likely to die because doctors are taking too long to assess their condition once they get to hospital, a study says.

Prompt diagnosis means that patients can be moved to specialist stroke units to take advantage of the latest technology.

Research shows that patients are more likely to survive if they are taken to a dedicated stroke unit as soon as possible.

But a study has shown that some patients are having to hang around in hospital receiving units while busy doctors cope with other patients or deliberate over making a definite diagnosis.

'Insupportable' delays

Publishing their findings in The Lancet medical journal, Dr Joanna Wardlaw, of the Western General Hospital in Edinburgh, and colleagues said the delays were "insupportable".

Future treatments would be useless unless patients could gain fast access to them, they said.

They followed 32 patients who had been admitted to hospital with suspected strokes, and noted the cause of delays at each stage of their progress to a ward.

About a quarter of patients arrived in hospital within three hours of the stroke starting, and nearly half within six. Most had been referred by their GP.

The delays in the hospital's acute receiving unit were largely down to doctors being busy with other patients - 79% of cases - or uncertainty over diagnosis - about half of patients had two or more possible diagnoses.

Speeding up treatment

They said that while most GPs were doing well at getting patients to hospital fast, there was room for improvement.

This would require educating the public, and persuading GPs and ambulance services to make a special effort.

However, they said: "GPs and ambulance staff will not look favourably on demands for greater effort on their part without there being much more rapid implementation of appropriate care on arrival at hospital."

They said hospitals should consider a fast-track scheme such as that for heart attack patients.

Line of attack

Dr Wardlaw told BBC News Online that part of the problem was there were so many doctors in the receiving units with different interests and priorities that nobody knew exactly what to do when a stroke patient arrived.

"We need to establish a clear line of attack so if a stroke patient comes in you know that you have to do this, do that and get them on a ward," she said.

"Getting those patients to co-ordinated care more quickly may well improve the patient's chances of survival, and reduce their chances of complications which in turn contributes to improving the overall outcome of stroke."

While this study was confined to one hospital, Dr Wardlaw said she suspected many hospitals across the UK and Europe were in a similar position.

Stroke care 'not the best'

Eoin Redahan, of the Stroke Association, said he was not surprised by the findings.

"The association has looked at the care of patients around the country, and it's not the best it could be."

Despite the evidence that dedicated stroke units saved lives, only 50% of patients had access to one, he said.

And another survey had shown that although many hospitals had the right equipment, but it was rarely accessible 24-hours a day.

"The situation needs improving especially with new treatments coming on board that have to be given within three to six hours of the stroke."

The Royal College of Physicians is due to publish guidelines on the diagnosis and immediate treatment of stroke later this year.



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