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Acute stroke clinical care standard indicators: 1b-Assessment in the emergency department

Identifying and definitional attributes

Metadata item type:Help on this termIndicator
Indicator type:Help on this termIndicator
Short name:Help on this termIndicator 1b-Assessment in the emergency department
METeOR identifier:Help on this term627677
Registration status:Help on this termHealth, Candidate 14/03/2017
Description:Help on this term

Proportion of patients admitted to hospital following presentation to the emergency department (ED) with a final diagnosis of acute stroke who were screened for stroke in the ED using a validated stroke screening tool.

Rationale:Help on this term

Early recognition of acute stroke symptoms is critical to ensuring optimal outcomes for stroke patients (NSF 2010).

Indicator set:Help on this termClinical care standard indicators: acute stroke Health, Candidate 14/03/2017
Outcome area:Help on this termEarly assessment Health, Candidate 14/03/2017

Collection and usage attributes

Computation description:Help on this term

Both the numerator and the denominator include patients admitted to hospital following presentation to the ED with a final diagnosis of acute stroke. The final diagnosis may be made at the hospital where the patient presented to the ED, or at another hospital within the local hospital network where the patient was transferred subsequent to their presentation to the ED.

For the numerator, some validated screening tools for stroke include the F.A.S.T. (Face, Arm, Speech and Time) test (NSF 2015) and the Recognition of Stroke in the Emergency Room (ROSIER) scale (Nor et al. 2005).

The F.A.S.T. test is:

  • FACE: Check their face. Has their mouth drooped?
  • ARM: Can they lift both arms?
  • SPEECH: Is their speech slurred? Do they understand you?
  • TIME: Time is critical. If you see any of these signs call 000 straight away.

The ROSIER scale has been found to sensitively identify stroke, thereby helping ED staff to make appropriate referrals to the stroke team.

Both the numerator and denominator exclude:

  • patients whose stroke occurred after admission to hospital for management of other conditions
  • inter-hospital transfer (within two days of admission) with diagnosis of acute stroke
  • unconscious patients.

Presented as a percentage.

Computation:Help on this term

(Numerator ÷ denominator) x 100

Numerator:Help on this term

Number of patients admitted to hospital following presentation to an ED with a final diagnosis of acute stroke who were screened for stroke in the ED using a validated stroke screening tool.

Denominator:Help on this term

Number of patients admitted to hospital following presentation to an ED with a final diagnosis of acute stroke.

Representational attributes

Representation class:Help on this termPercentage
Data type:Help on this termReal
Unit of measure:Help on this termEpisode
Format:Help on this term

N[NN]

Source and reference attributes

Submitting organisation:Help on this term

Australian Commission on Safety and Quality in Health Care

Reference documents:Help on this term

NSF (National Stroke Foundation) 2010. Clinical guidelines for stroke management. Melbourne: NSF

Nor AM, Davis J, Sen B, Shipsey D, Louw SJ, Dyker AG et al. 2005. The recognition of stroke in the emergency room (ROSIER) scale: development and validation of a stroke recognition instrument. Lancet Neurology 4(11):727-734

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