referral criteria from primary care - admission for CVA

Last edited 06/2019

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