A clinical audit on recognition and management of stroke in a tertiary care hospital of Sri Lanka

Background:  Stroke is a major cause of mortality and morbidity worldwide, with a significant burden in low- and middle-income countries. This audit evaluated the impact of introducing validated tools, the FAST test and ROSIER score, to improve stroke recognition and treatment initiation by outpatient doctors at a tertiary care hospital in Sri Lanka.
Methods: A two-cycle audit was conducted. The first cycle involved retrospective data collection over 12 months, followed by two weeks of training and three months of implementation for outpatient doctors and the medical team on the use of the FAST and ROSIER tools. The second cycle involved prospective data collection over three months with the use of the same implemented tools.
Results: Twenty-eight patients [median age 67(IQR 9) years; male: 20, female: 8] and eleven patients [median age 77.5(IQR 14) years; male: 5, female: 6] were included in the first and second cycles of the audit, respectively. Stroke onset was documented in 64% of patients during the first cycle and in 100% of patients during the second. Disability was specified in 82% of patients in the first cycle and 100% of patients in the second. CT scans were performed within a median of 75 minutes (IQR 123) and 52 minutes (IQR 58) after arrival in the first and second cycles, respectively. Three patients received aspirin and four received antihypertensives before CT in the first cycle, compared to none in the second.
Conclusion: There has been a substantial and meaningful improvement in the recording of disability and early recognition of stroke, timely diagnosis, and initiation of management following the intervention comprising, implementation of the FAST test, ROSIER score and National Stroke Guidelines.