Stroke and Transient Ischaemic Attack in Over 16s: Diagnosis and Initial Management
National Institute for Health and Care Excellence. (2019).
London (United Kingdom): National Institute for Health and Care Excellence, (NG128), 1-48.
This evidence-based guideline provides recommendations for the diagnosis and acute management of acute stroke and transient ischemic attack. Recommendations relevant to the scope of speech-language pathology are included within this article summary.
National Institute for Health and Care Excellence
This guideline was reviewed with the following: <br />
<ul>
<li><span style="color: #333333;">National Institute for Health and Care Excellence. (2010). Stroke in Adults (Quality Standard 2). Retrieved from www.nice.org.uk</span></li>
</ul>
Everyone with suspected stroke should be admitted directly to a specialist acute stroke unit (i.e., a discrete area in the hospital staffed by a multidisciplinary team with specialized knowledge regarding stroke) after initial assessment. This unit should have regular multidisciplinary meetings for the purpose of goal setting and access to equipment for monitoring and rehabilitating patients. Admission to the acute stroke unit may occur from the community, the emergency department, or outpatient clinics.
Recommendations for swallowing screening and assessment following acute stroke are as follows: <br />
<ul>
<li><span style="color: #333333;">Upon admission, a swallow screening should be conducted by an appropriately trained healthcare professional prior to any PO intake (e.g., food, fluid, medication). </span></li>
<li><span style="color: #333333;">If this swallow screen indicates problems with swallowing, "the person [should receive] a specialist assessment of swallowing, preferably within 24 hours of admission and not more than 72 hours afterwards" (p. 18). </span></li>
<li><span style="color: #333333;">Individuals with suspected aspiration upon specialist assessment, or those who require alternative feeding or dietary modification for 3 days, should be "re-assessed and considered for instrumental examination [and] referred for dietary advice" (p. 18).</span></li>
</ul>
"To avoid aspiration pneumonia, give food, fluids and medication to people with dysphagia in a form that can be swallowed without aspiration, after specialist assessment of swallowing" (p. 20).
