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Identify stroke patients and optimize therapy

In the first 3 hours after onset of stroke, the speed of emergency response is critical

  • Time taken to initiate thrombolytic treatment following the onset of stroke symptoms affects the extent of tissue damage and the possibility of recovery without impairment1
  • Patient selection, treatment, and evaluation guidelines or policy statements* have been set forth by a number of organizations and associations to help quickly2,3:
    • – Identify potential stroke patients
    • – Diagnose severity of stroke
    • – Determine patient eligibility for various types of therapy

Click on the links below for more information on these guidelines and stroke evaluation scales

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F.A.S.T. prehospital stroke screening tool

  • F.A.S.T. materialsThe F.A.S.T. system is designed to be a quick prehospital stroke screening tool based on assessment of facial expression, arm movement, and speech function
  • If an abnormality exists in any of these areas — face, arms, speech — a stroke should be strongly suspected and the patient should be taken to the nearest certified stroke center
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Los Angeles Prehospital Stroke Screen (LAPSS)4

  • LAPSS is a simple checklist designed to allow EMS personnel to rapidly identify acute stroke patients in the field
  • 1-page instrument that may be completed in under 3 minutes
  • Consists of 4 history items, a blood glucose measure, and 3 examination items designed to detect unilateral motor weakness
  • Items were designed to identify the most common acute stroke symptoms and also to exclude most stroke mimics

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In-hospital stroke assessment scales3

ScaleDescriptionRangeFavorable score*What the scores mean
National Institutes of Health Stroke Scale (NIHSS) A serial measure of neurologic deficit on a 42-point scale across 11 categories — including paralysis, speech difficulty, and sensory and visual loss 0 to 42 (the lower the score, the better the outcome) <1 0=typically normal function without neurologic deficit
1=mild facial paralysis
>22=severe stroke symptoms
25=complete right hemiplegia with aphasia, gaze deviation, visual
deficit, dysarthria, and sensory loss
Barthel Index Measures the ability to perform activities of daily living — eg, eating, bathing, walking, and using the toilet 0 to 100 (the higher the score, the better the outcome) 95 or 100 100=able to perform all activities of daily living with complete independence
Modified Rankin Scale A simplified overall assessment of function 0 to 5 (the lower the score, the better the outcome) 0 or 1 0=absence of symptoms
5=severe disability
Glasgow Outcome Scale A global assessment of function — from good to vegetative state and death 0 to 5 (the lower the score, the better the outcome) 1 1=good recovery
2=moderate disability
3=severe disability
4=survival, but in a vegetative state
5=death
  • *
  • Favorable scores are associated with either normal or near-normal status.


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National Institutes of Health Stroke Scale (NIHSS)

The NIHSS is a standard assessment tool:

  • A measure of neurologic deficit, the NIHSS can be used to quantify neurologic function in specified categories at various time points, such as3:
    • – Admission (baseline), 2 hours after treatment, 24 hours after onset of symptoms, 7-to-10 days after hospital admission, or 3 months postadmission
  • To view a video clip on the use of the NIHSS to assess actual stroke patients, click here.
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NIHSS training

The National Institute of Neurological Disorders and Stroke (NINDS) interactive 2-DVD training tool for administering and scoring the NIHSS.

The set features:

  • Detailed instruction on each scale item to teach you how to administer and score all items in the NIHSS
  • Two demonstration cases to test your skill by allowing you to score the results before hearing the examiner provide the score
  • Three full certification sets of 6 patients each that allow you to score patients and submit your answers to an accrediting organization for certification; and
  • An introduction and commentary from leading stroke experts who provide insight on the significance of the NIHSS and tips for proper scoring

Link now:

Genentech is neither affiliated with nor endorses any of these organizations listed above.

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Stroke assessment card ring

Stroke assessment card ringThese laminated cards, held together with a single ring, are a crucial emergency department reference tool that includes:

  • NIHSS and other stroke assessment scales
  • Protocols for ischemic stroke management
  • Guidelines for diagnostic evaluation

The compact cards can be tucked into a pocket or hung on a hook for easy access

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Treatment guidelines and consensus statements

To help facilitate patient selection and treatment, professional organizations — dedicated to the improvement of stroke patient outcomes — have published practice guidelines or consensus statements that address†:

  • Management of patients exhibiting signs and symptoms of acute ischemic stroke
  • Administration of Activase (Alteplase) in eligible patients

Learn more

Genentech is neither affiliated with nor endorses any of these organizations.

  • †
  • Note: Each set of these protocols and guidelines represents only one possible approach to the treatment of eligible acute ischemic stroke patients. Individual healthcare practitioners and institutions must exercise professional judgment in creating or adopting treatment protocols or guidelines, as well as in the treatment of each individual patient.


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Indication
Activase (Alteplase) is indicated for the management of acute ischemic stroke in adults for improving neurological recovery and reducing the incidence of disability. Treatment should only be initiated within 3 hours after the onset of stroke symptoms, and after exclusion of intracranial hemorrhage by a cranial computerized tomography (CT) scan or other diagnostic imaging method sensitive for the presence of hemorrhage (see CONTRAINDICATIONS).

Important Safety Information
Activase therapy in patients with AIS is contraindicated in certain situations (eg, suspicion of subarachnoid hemorrhage on pretreatment evaluation, recent (within 3 months) intracranial or intraspinal surgery, history of intracranial hemorrhage, uncontrolled hypertension at time of treatment, active internal bleeding, known bleeding diathesis (eg, current use of oral anticoagulants, administration of heparin within 48 hours of onset of stroke, platelet count <100,000) (see CONTRAINDICATIONS for full list).

The most common complication during Activase therapy is bleeding. Should serious bleeding in a critical location (intracranial, gastrointestinal, retroperitoneal, pericardial) occur, Activase therapy should be discontinued immediately. Death and permanent disability are not uncommonly reported in patients who have experienced stroke (including intracranial bleeding) and other serious bleeding episodes.

The risks of Activase therapy may be increased and should be weighed against the anticipated benefits in certain conditions. [See WARNINGS in full prescribing information].

  • Patients with severe neurological deficit (eg, NIHSS >22) at presentation. There is an increased risk of intracranial hemorrhage in these patients.
  • Patients with major early infarct signs on a computerized cranial tomography (CT) scan (eg, substantial edema, mass effect, or midline shift).

Treatment of patients with minor neurological deficit or with rapidly improving symptoms is not recommended.

Orolingual angioedema has been observed in postmarketing experience in patients treated with Activase for AIS. Patients should be monitored during and for several hours after infusion for signs of orolingual angioedema.

Please click here for full prescribing information.
References:
1.
Wahlgren N, Ahmed N, Dávalos A, et al. Thrombolysis with alteplase for acute ischaemic stroke in the safe implementation of thrombolysis in stroke-monitoring study (SITS-MOST): an observational study. Lancet. 2007;369:275-282.
2.
Mohd Nor A, McAllister C, Louw SJ, et al. Agreement between ambulance paramedic- and physician-recorded neurological signs with face arm speech test (FAST) in acute stroke patients. Stroke. 2004;35:1355-1359.
3.
National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Recombinant tissue plasminogen activator for minor strokes: the National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Experience. N Engl J Med. 1995;333:1581-1587.
4.
Kidwell CS, Starkman S, Eckstein M, et al. Identifying stroke in the field: prospective validation of the Los Angeles Prehospital Stroke Screen (LAPSS). Stroke. 2000;31:71-76.