[Improvements of standards in clinical diagnosis of stroke are needed]

A detailed history, neurological examination, and assessment of function are essential procedures in all patients with stroke. Findings need to be adequately documented in the medical records. In a recent study, the documentation of 106 core items in stroke management, as specified in the Swedish National Guidelines for Stroke Management, was evaluated in the records of 70 randomly selected stroke patients treated at 17 hospitals in two county councils between March and May of 2001. The initial screening process and neurological examination were adequately documented in fewer than 50% of the patients. Clinical workup of stroke in routine practice needs to be improved. It is proposed that the documentation of core items be standardized, and that a well validated stroke scale (NIH Stroke Scale), at present mainly used in conjunction with acute thrombolytic therapy, be generally applied to all patients with stroke.