Software could cut strokes

Up to 50 people a year could be spared disabling or fatal strokes as Manawatu doctors use a software programme to help diagnose and manage mini-strokes.

The potentially life-saving software was designed by MidCentral Health neurologist Dr Anna Ranta to help general practitioners manage patients who suffer from transient ischaemic attacks (TIAs), which are small strokes that cause temporary numbness, weakness, or speech problems.

The Manawatu is the first region in New Zealand to trial the groundbreaking system.

Stroke is New Zealand's second-highest cause of death and a leading cause of disability.

Some people have warning symptoms that give doctors time to intervene and prevent the big one.

If left undiagnosed, 30 per cent of TIA cases will turn into full strokes.

However, if they are recognised in time, medicated, and investigated with the right tests soon enough, TIAs can be prevented from becoming a full stroke.

Palmerston North GP Greig Russell said the New Zealand-first programme helped GPs work through a person's stroke risks the same way a hospital registrar or stroke specialist would – by using the same evidence-based best practice.

It leads the doctor through the questions to ask and the information to enter.

"What we're looking for are those people for whom intervention will change the outcome," he said.

By using the software program, doctors can rule out TIA and reassure the patient, start medication, order further tests, or refer them to hospital.

The programme assesses risks and tells a GP what to do, from calling an ambulance immediately, administering aspirin and referring the patient to the emergency department within 24 hours, or making a less urgent clinic referral.

The Manawatu Standard was given an insight into the use of the software.

Dr Russell assessed a fictional 45-year-old Maori man with slightly raised blood pressure, whose symptoms of sudden weakness on one side had gone away by the time he saw the doctor.

The programme calculated the risk of a stroke within the next seven days was 5.9 per cent, and recommended immediate aspirin and an emergency department referral. It also suggested the patient was very young to have had a TIA, and suggested other diagnoses should be considered.

The software was launched last October, and early results show the number of people being referred to Palmerston North Hospital's TIA clinic has dropped from 7.5 to four a month.

"The software helps us triage out those where a TIA can be ruled out, and those who are very straight forward and at low risk who can be looked after in the community. That leaves us more time to see people who are either very complex or at highest risk," Dr Ranta said.

With resources stretched, it made sense to concentrate on those patients with a high risk of a stroke within seven days.

For TIA patients, starting medications promptly – aspirin, statins, and blood pressure lowering drugs – slashed the risk of a stroke within 90 days from up to 18 per cent to 1.2 per cent and GPs could do it at the first consultation.

"We know it works. Even if they do nothing else, it means we won't see those patients next week in the hospital with a stroke," she said.

The next tier of stroke management is a CT scan and, for some people, a carotid ultrasound to look for unstable blockages in the arteries to the brain.

If the ultrasound spots trouble, people can be sent to Wellington for vascular surgery to remove the blockage and prevent a stroke.

Dr Ranta said other district health boards were starting to ask about adapting the decision software for use in their communities.

- © Fairfax NZ News