Referral criteria from primary care - admission for CVA

The National Service Framework for older people states that all patients with acute stroke require urgent admission to hospital to allow:

• medical stabilisation
• assessment of factors that may lead to complications

Note that the availability of thrombolysis for CVA will have an impact on local referral protocols:

NICE (2,3) have stated with reference to thrombolysis in stroke that:

• alteplase is recommended for the treatment of acute ischaemic stroke when used by physicians trained and experienced in the management of acute stroke
• treatment must be started within 3 hours of onset of the stroke symptoms and after prior exclusion of intracranial haemorrhage by means of appropriate imaging techniques

All people with suspected stroke should be admitted directly to a specialist acute stroke unit following initial assessment, either from the community or from the A&E department (2).

NICE (2) :

• Initial management of suspected and confifirmed TIA
  • offer aspirin (300 mg daily), unless contraindicated, to people who have had a suspected TIA, to be started immediately
    
    
  • refer immediately people who have had a suspected TIA for specialist assessment and investigation, to be seen within 24 hours of onset of symptoms
    
    
  • do not use scoring systems, such as ABCD2, to assess risk of subsequent stroke or to inform urgency of referral for people who have had a suspected or confirmed TIA
    
    
  • offer secondary prevention, in addition to aspirin, as soon as possible after the diagnosis of TIA is confirmed

Reference:

• (1) GP magazine (3/8/01), 23-4.
• (2) NICE (May 2019). The diagnosis and acute management of stroke and transient ischaemic attacks
• (3) NICE (June 2007).Alteplase for the treatment of acute ischaemic stroke.