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Practice Guidelines

Diagnosis and initial management of acute stroke and transient ischaemic attack: summary of NICE guidance

BMJ 2008; 337 doi: (Published 24 July 2008) Cite this as: BMJ 2008;337:a786
  1. Sharon Swain, health services research fellow in guideline development1,
  2. Claire Turner, senior project manager in guideline development for the development group1,
  3. Pippa Tyrrell, senior lecturer2, honorary consultant in stroke medicine3,
  4. Anthony Rudd, consultant stroke physician 4
  5. on behalf of the Guideline Development Group
  1. 1National Collaborating Centre for Chronic Conditions, Royal College of Physicians of London NW1 4LE
  2. 2Stroke Medicine, University of Manchester, Manchester
  3. 3Salford Royal NHS Foundation Trust, Salford M6 8HD
  4. 4St Thomas’s Hospital, London SE1 7EH
  1. Correspondence to: S Swain Sharon.Swain{at}

    Why read this summary?

    In England, stroke is estimated to cost the economy about £7bn (€8.8bn; $13.9bn) a year. This total comprises direct costs to the National Health Service of about £2.8bn, cost of informal care of £2.4bn, and cost because of lost productivity and disability of £1.8bn.1 In the United Kingdom, the national sentinel stroke audits2 3 have shown that over the past 10 years increasing numbers of patients are being treated in stroke units, evidence based practice is increasing, and reductions in mortality and length of hospital stay have decreased. One of the main aims of the guidance issued by the National Institute for Health and Clinical Excellence (NICE) is to ensure that the specialist treatment and expertise recommended are available to all patients in England and Wales. This article summarises key recommendations in the NICE guideline for the diagnosis and initial management of acute stroke and transient ischaemic attack.4


    NICE recommendations are based on systematic reviews of best available evidence. When minimal evidence is available, recommendations are based on the guideline development group’s opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

    Rapid symptom recognition and diagnosis

    Outside hospital

    For people with sudden onset of neurological symptoms, use a validated tool such as the face, arm, speech test (FAST)5 to screen for a diagnosis of stroke or transient ischaemic attack.[Based on moderate quality cohort studies and on the opinion of the Guideline Development Group (GDG)]

    In hospital

    For people who are admitted to an accident and emergency department with a suspected stroke or transient ischaemic attack, establish the diagnosis rapidly using a validated tool such as ROSIER (Recognition of Stroke in the Emergency Room).6 [Based on moderate quality cohort studies and on the GDG’s opinion]

    Brain imaging for suspected transient ischaemic attack

    For people who have had a suspected …

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