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Simple tool can aid GPs' stroke referral

A UK research team has developed a three-minute assessment tool designed to improve GPs' referrals for stroke.

The five-point tool relies on simple yes/no assessment of limb weakness, speech disturbance, visual field defect and whether the patient is unconscious or confused (see box).

A study presented at this week's International Stroke Conference in Kissimmee, Florida, successfully validated the tool in two studies of more than 700 suspected stroke patients.

Study leader Professor Gary Ford, professor of pharmacology of old age at the University of Newcastle, said: 'There are always patients who present to primary care and we've got to have ways to pick that up.'

Professor Ford, head of his faculty's stroke research group, added: 'Sometimes non-stroke conditions are not considered and people with sepsis then don't get treatment. Some of these require urgent admission ­ it's a way of increasing awareness of what is a stroke.'

He estimated the system ­ called the Primary Care Referral Stroke Identification Tool, or Presit ­ would take about three minutes to use.

The first study used Presit to evaluate 470 suspected stroke patients, who were ultimately diagnosed with stroke in 264 cases, transient ischaemic attack in one case and non-strokes in 205 ­ the most common mimics being sepsis, seizure and syncope. The tool had a sensitivity of 90 per cent and specificity of 86 per cent.

The second study of 243 consecutive stroke referrals assessed sensitivity as 94 per cent and specificity as 72 per cent.

Dr Jonathan Mant, senior lecturer in the department of primary care and general practice, University of Birmingham, said: 'It still makes a lot of mistakes and there are a lot of people we [would] send in who haven't had stroke, but simple tools like this that can be used quickly are to be welcomed.'

Dr Brendan Boyle, Huntingdonshire PCT stroke lead, said: 'The simpler the tool the more useful it could prove to be. Anything which might make referral more appropriate would lead to a more efficient use of services.'

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