Priority 2 Stroke Prevention, Diagnosis, Pre-hospital and Hospital Care

UNCERTAINTY: How can the public, paramedics and other health care professionals recognise and respond to stroke or TIA better and more quickly? (JLA PSP Priority 2)
Overall ranking	2
JLA question ID	0106/2a
Explanatory note	There are two aspects - recognition and response by (a) the public, and (b) paramedics and other professionals. Public awareness campaigns using FAST don’t reach all UK populations, does not cover symptoms in many cases. Even where symptoms are recognised, people may not know how to respond (see original submissions). There is very little evidence on recognition of TIA. A 2019 Cochrane Review (see Evidence) "evaluating the accuracy of stroke recognition scales used in a prehospital or ER setting" concluded that "because of the small number of studies per test per setting, high risk of bias, substantial differences in study characteristics and large between‐study heterogeneity, these findings should be treated as provisional hypotheses that need further verification in better‐designed studies". Evidence is needed to improve recognition and response to stroke and TIA to reduce death and disability caused by stroke.
Evidence	https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011427.pub2/full https://pubmed.ncbi.nlm.nih.gov/26574548/
Health Research Classification System category	Stroke

Extra information provided by this PSP
Original uncertainty examples	Why aren’t the differences between certain types of strokes sufficiently explained? For example I had a cerebella stroke and I was passing all of the stroke FAST tests? I was first diagnosed with an ear infection. ~ Differentiating between TIA, minor stroke and stroke mimics. ~ What types of stroke advocacy strategies can lead to improvements in stroke awareness and knowledge among lay people? ~ How can we raise public awareness of aphasia?
Submitted by	Health/Social Care professional x 40, Stroke Survivor x 42, Carers x 20, Not stated x 1, Research Recommendations x 9

Extra information provided by this PSP

Original uncertainty examples

Why aren’t the differences between certain types of strokes sufficiently explained? For example I had a cerebella stroke and I was passing all of the stroke FAST tests? I was first diagnosed with an ear infection. ~ Differentiating between TIA, minor stroke and stroke mimics. ~ What types of stroke advocacy strategies can lead to improvements in stroke awareness and knowledge among lay people? ~ How can we raise public awareness of aphasia?

Submitted by

Health/Social Care professional x 40, Stroke Survivor x 42, Carers x 20, Not stated x 1, Research Recommendations x 9

PSP information
PSP unique ID	0106
PSP name	Stroke prevention, diagnosis, pre-hospital and hospital care
Total number of uncertainties identified by this PSP.	93 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	30th April 2021