Patients with stroke symptoms 'wait too long for treatment'

PATIENTS with symptoms of stroke are missing out on life- saving operations because they fail to recognise the signs, and even if they do, they are routinely treated as low-priority cases in the NHS, a UK surgical audit has claimed.

Its research has shown stroke sufferers in Scotland face a postcode lottery when it comes to hitting vital referral and treatment deadlines.

The UK Audit of Vascular Surgical Services and Carotid Endarterectomy has prompted surgeons to call for an urgent review of vascular services.

Ensuring high-risk patients are fast-tracked into hospital, would, it claims, avoid hundreds of needless deaths every year.

However, it says a lack of public awareness of the symptoms of transient ischemic attack (TIA), or mini stroke, combined with poor professional understanding of treatment and referral options, means that, instead of being treated as emergency cases at the first sign of symptoms, thousands of patients are waiting weeks or sometimes months for an operation that may be of no benefit by that time.

The operation, called a carotid endarterectomy, should be carried out within 48 hours and no longer than 14 days after symptoms appear.

The figures show that, while Scotland's NHS boards were, on average, either on a par with or better than the rest of the UK in hitting these targets, a breakdown of local performance revealed a patchier picture.

The audit, commissioned by the Vascular Surgical Society and carried out at the Royal College of Physicians, said there was "irrefutable evidence" that patients who show symptoms were at risk of having a severe stroke if they did not receive surgery to the neck arteries as soon as possible.

Rod Chalmers, consultant vascular surgeon at Edinburgh Royal Infirmary - part of NHS Lothian, which returned consistently high treatment scores - said communication across hospitals and surgeries was key to speedy treatment.

"In Lothian some years ago, we went to great pains to hasten the referral," he said. "When a patient is first seen by stroke physicians and if it's in their own hospital that's ideal, because they come to us the same day and are operated on within a few days. But if it is another hospital that the patient is first seen, obviously there can be delays, and we're always keen to improve on that."

Mr Chalmers said there had been a step-change in the amount of work being done to make sure stroke services were available to respond as quickly as possible, but that further work had to be done to make the public aware of the spectrum of symptoms for a stroke.

David Clark, chief executive of Chest Heart & Stroke Scotland, said of the figures: "The Scottish Action Plan for Heart Disease and Stroke has already highlighted the need for improvements in carotid endarterectomy services. This report shows that there is still much to be done in Scotland, as in the rest of the UK, as these improvements will save lives and reduce disability."

WARNING SIGNS

THE symptoms of having a stroke can vary greatly - from as minor as numbness in a patient's hand to loss of consciousness.

The main stroke signs occur in the person's face arms and speech.

Their face may have fallen on one side, and the sufferer may not be able to smile, or their mouth or eye may have drooped.

They may not be able to raise both arms and keep them aloft because of arm weakness or numbness. These symptoms may be accompanied by slurred speech and difficulty speaking.

Other signs can include dizziness, problems with balance and co-ordination, difficulty swallowing, severe headaches and complete paralysis of one side.