Clinical Practice Guideline for the Management of Stroke ...

1 Clinical Practice Guideline for the Management of Stroke Patients in Primary Health Care NOTE: It has been 5 years since the publication of this Clinical Practice Guideline and it is subject to updating. The recommendations included should be considered with caution taking into account that it is pending evaluate its validity. Clinical Practice guidelines IN THE SPANISH NATIONAL HEALTHCARE SYSTEM. MINISTRY OF HEALTH, SOCIAL POLICY, AND EQUALITY. Clinical Practice Guideline for the Management n g. i of Stroke Patients in up d at to Primary Health Care bj ec t su is it d an e l in de ui G.

2 I ce act r a lP. ic il n C. s thi of n io at ic u bl p e th nce si a rs ye 5. een b has It Clinical Practice guidelines IN THE SPANISH NHS. MINISTRY OF HEALTH AND SOCIAL POLICIES. g. a tin p d u o c tt bje su s iti d an e l in d e ui G. e tic for the Clinical judgement of health care This CPG is a health care decision aid. It is not mandatory and it is not a substitute c ra personnel. P. c al i lin C. i s f th o n a tio b lic pu e th n ce si a rs ye 5. e en b has Version: 2009. t Published by: Ministry of Science and Innovation I ISBN: 978-84-451-3293-7. INOP: 477-09-050-7.

3 Copyright deposit. M-9784-2010. Printed by: ESTILO ESTUGRAF IMPRESORES, Pol. Ind. Los Huertecillos, nave 13 - 28350 CIEMPOZUELOS (Madrid). g. a tin p d u o c tt bje su is it d an e l in i deagreement signed by the Instituto de Salud Carlos II, an independentubody of the Ministry of Science and This CPG has been funded through the G Assessment Unit of the Lain Entralgo e within Innovation, and the Health Technology Agency of the Community ofcMadrid, ti for the National Health System of the Ministry the framework of collaboration c provided for in the Quality Plan ra of Health and Social Policy.

4 P. c al i lin C. i s f th o n io at ic u bl p e th nce si a rs ye 5. een b has It This Guideline must be quoted: Clinical Practice Guideline Development Group for the Management of Stroke Patients in Primary Health Care. Clinical Practice Guideline for the Management of Stroke Patients in Primary Health Care. Quality Plan for the National Health System of the Ministry of Health and Social Policies. Health Technology Assessment Unit of the Lain Entralgo Agency of the Community of Madrid; 2009. Clinical Practice guidelines in the Spanish NHS: UETS No. 2007/5-2. Contents Presentation 9.

5 G. Authors and collaborations 11. a tin p d Questions to be answered 15 u t o t Recommendations j ec 17. sub s ti 1. Introduction 27. i d 2. Scope and objectives an 33. e l in 3. Methodology de 35. ui 4. G. ce Definition and Classifications 37. ti ac Definition and nomenclature 37. P r al Stroke classification 39. n ic Etiologic classification of ischaemic Stroke 40. li C. Etiologic classification of haemorrhagic Stroke 40. s t International Classification ofhiDiseases and International Classification of Primary Health Care f o 41. ti on 5. Clinical diagnosis of Stroke a 43.

6 Lic b of Stroke pu Suspicion criteria 43. e Anamnesis th 49. n ce exploration and biological parameters si Physical 52. rs Differential diagnosis 53. ea Pre-hospital scales 5 56. e n b e6. Pre-hospital Management of acute Stroke 61. has Priority measures 61. It Initial measures 61. Urgent detection/care 61. Pre-hospital Stroke code 62. Stroke units 64. Management of blood pressure 68. Clinical Practice guidelines IN THE SPANISH NHS 5. Management of glycaemia 71. Supplementary oxygen therapy 74. Antiplatelet treatment 76. Fluid replacement therapy 78. g. a tin d 7.

7 Management of communicated Stroke 79. u p 8. Management of Stroke after hospital discharge o t83. t Monitoring the patient after discharge j ec 84. sub s General rehabilitation measures after a Stroke 85. iti Sequelae and common complications after a Stroke d 87. Physical problems an 88. Impairments and limitations assessment ine el 88. d ui Spasticity 89. Shoulder pain G 92. e tic Central post Stroke pain 94. Dysphagia c 97. Falls P ra 102. Psychological problems c al 106. i Depression lin 106. Anxiety C 111. i s Emotionalism f th 112. o Cognitive affectation 113.

8 Social or familyn problems in the patient's environment tio of Daily Living 116. c a Activities 116. li Return to work b 117. pu Driving 118. e t Sexuality 119. nce role: Nursing diagnoses Nursing 120. si s 9. ar Information and communication to patient 141. ye 5 Diagnostic and therapeutic strategies en 10. 145. be11. as Dissemination and implementation 147. t h I Dissemination and implementation strategy 147. Proposed Quality Indicators 148. 12. Future research recommendations 151. 6 Clinical Practice Guideline FOR THE Management OF Stroke PATIENTS IN PRIMARY HEALTH CARE.

9 13. Appendices 153. Appendix 1 Evidence levels and recommendation degrees 154. Appendix 2 Main guidelines consulted as secondary source of evidence 156. Appendix 3 Data collection sheet in acute Stroke 157. Appendix 4 Cincinnati Prehospital Stroke Scale (CPSS) 158. g. Appendix 5 Melbourne Ambulance Stroke Screen (MASS) 159. i n at Appendix 6 Stroke code (Community of Madrid) 160. Appendix 7 Functional evaluation scales: Rankin, Barthel, FIM 161. d Appendix 8 Information for patients 165 up Appendix 9 Glossary and abbreviations t to 200. c 205. Appendix 10 Conflict of interest declaration bje su s ti Bibliography 206.

10 I d an e l in d e ui G. ti ce r ac P. al ic lin C. s thi of n io at b lic pu t he nce si a rs ye 5. en b e has It Clinical Practice guidelines IN THE SPANISH NHS 7. Presentation Health care Practice is becoming more and more complicated due to many different factors. One of the most relevant factors is the increase of scientific information available to us. Science is permanently changing so the knowledge to be able to cover the health care needs and the illness g. needs effectively and safely must be constantly refreshed. atin In 2003, the Inter-territorial Board of the National Health System (SNS) created the Gu aSalud d project.