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Trying desperately not to get drawn into the specifics of stroke management at this stage, I think Matthew's more general point should at least be considered. However getting ambulances to triage patients to "ward versus A&E" strikes me as requiring a "leap of faith" way beyond my current experience of the ambulance service, who seem to have difficulty in suggesting self-care or GP-care to many of my patients. Why not start at the slightly more achievable end of the spectrum, and simply get GP-expected patients to go straight to the ward? After all, they've already been assessed by a GP, who should've commenced any urgent treatment. If we could achieve this first, then we may not need to lose our 999 calls as well; besides we should be careful to keep some work in our departments! But returning to strokes (I couldn't resist), if "strokes are strokes" in my homeland, that most western isle of Europe, then why not send at least some of them home? GPs still, I believe, in some parts of the country, treat certain stroke patients at home where there is adequate care, and where acute medical intervention either is not planned or is contra-indicated. It's a logical extension of Matt's argument really; if we're not going to do anything for a stroke patient, then there's little point in admitting them. This might also hold true for the younger patient with a small stroke but for converse reasoning; while they need to be worked up, CT, echo, doppler etc, this can often be done as an outpatient. Adrian Fogarty ----- Original Message ----- From: Renee Nilan To: [log in to unmask] Sent: Monday, December 02, 2002 2:28 AM Subject: Re: See and Treat I have a question about this statement. Wouldn't this patient benefit from a head CT to determine whether or not this is a hemorrhagic versus non-hemorrhagic stroke? The treatment may be vastly different. I know in the US we tend to be excessive in our use of tests and at times overly aggressive in our treatment strategies. I would like to understand the difference in this case. In the US a patient like this would definitely go to the ED for a head CT and if the stroke was found to be hemorrhagic in nature they would then have an angiography to determine whether the patient had an aneurysm amenable to surgical treatment. Renee