[The acute stage of the cerebrovascular accident; characteristics and management]

Description of stroke patient characteristics, outcome in the acute phase (the first 3 weeks post-stroke) and management by the general practitioner (GP).

Community based prospective study.

During the research period GPs reported all stroke patients (first event as well as recurring); these patients were followed at fixed intervals post-stroke regardless of treatment.

The 98 GPs reported 185 patients. Stroke patients are predominantly old to very old people with a lot of comorbidity and an impaired pre-stroke functional status. The GP treated one third of the patients himself; half of the patients were instantly referred to a hospital. Younger patients are referred for further examination, probably because of possible therapeutic consequences. The very old are referred if their impairment makes home care impossible. Mortality, especially in the hospital group is high; 10% died within 24 hours, while after 1 week this figure was 17% and after 3 weeks 23%. In 21% of the referred patients no CT scan was made; the motive for referral was to provide sufficient care for the patient. In nine referred patients (8%) the diagnosis was changed.

In choosing a strategy the GP considers several factors, of which impairment and the possibilities of home care are the most important. Diagnostic uncertainty played a minor role.