UK Stroke Forum 2025 | Best practices for the initial assessment of patients with stroke

It’s really important that when patients have stroke-like symptoms, they see an expert as quickly as possible. We are advocating that all ambulance services work with their comprehensive and acute stroke services to offer pre-hospital video triage. We believe that the six-minute consultation can rapidly assist in the diagnosis of both those patients having a stroke, but also those that are mimicking a stroke and don’t need to come to hospital. This is vital for patients and also ambulance teams and the stroke teams because they can spend the time required to look after stroke patients and not those mimicking stroke. We also advocate that they’re met at the front door by an experienced stroke clinician and go straight to the imaging department for their CT scanning in line with the National Optimal Stroke Imaging Pathway. We believe that access to CT scanning within 20 minutes is deliverable, providing they’ve had an appropriate pre-hospital video assessment. There are a group of patients that have very mild symptoms or one thinks are unlikely to be suffering a stroke and therefore the potential to have first-line MRI scanning should be available at least 12 hours a day and ideally 24 hours a day. There really is no benefit for patients and also hospital teams for patients remaining in hospital with mild symptoms overnight waiting for a scan in the morning. They should be able to get that scan when they need it, ideally an hour, a limited MRI series, and then have their recovery journey at home if appropriate.

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