Stroke is an Acute neurological impairment that follows interruption in blood supply to a specific
area of the brain. lt is classically characterized as a neurological deficit attributed to an acute focal
injury of the central nervous system (cNs) by a vascular cause, including cerebral infarction,
intracerebral hemorrhage (lCH), and subarachnoid hemorrhage (sAH), and is a major cause of disability and death.

Stroke is the second leading cause of death in Saudi Arabia and a leading cause of disability
in adults. The physical, emotional and financial consequences are felt by the patient, his/
her family, the community and the country. Stroke is a preventable and treatable disease.
The gap between evidence-based stroke medicine and care in Saudi Arabia is high. 

The Ministry of Health has identified stroke as a high priority disease that needs to be managed more appropriately

The Goal 

1. To reduce stroke complication , disability and death in accordance with global standards.
   
   
2. To outline the process of Stroke Management from admission to discharge from an acute 
   stroke unit bed.
3. To facilitate the delivery of best practice acute stroke care for all patients in the Qassim Area

patient stroke segmentation

Very high risk is patient with symptoms < 6 hours with or without comorbidity

High risk is patient with symptoms 48 hours with or without comorbidity or previous TIA or stroke

Moderate risk patient with symptoms 48 hours -2 weeks With or without comorbidity or pervious TIA or stroke

Low risk is patient with symptoms > 2 weeks with comorbidity or TIA

Very low risk  is patient with symptoms > 2 weeks with no comorbidity or TIA

Stroke assessment :

Act FAST sileening Tool is being used to triage patients who arrive between 6-24 hours from stroke symptom onset and helps guide rapid decision making in the Emergency Department. The Acr-FAST algorithm has high specificity and reliability for recognizing laige vessel occlusion in
severe stroke

• Face - Drooping of the face
• Arm - Arm weakness
• Speech - Slurred Speech
• Time - Time counts

Pre-hospital Stroke Triage is a screening procedure to identify stroke patients in the field and take them to the most appropriate hospital.

Stroke Triage shall be done by the EMS during patient transport or prior to arriving 
to the designated hospital or to the nearest Stroke Center ER. The Pre-hospital Stroke Triage 
shall consist of the following:

• Vital Signs
• GCS
• Glucose level (< 3.5 mmol/l is urgently corrected to normal prior to proceeding with ED 
  Stroke Triage Protocol)
•  Stroke recognition based on FAST screening

stroke code is an emergency response system in the hospital to manage suspected strokes. The system can be activated by dialing a designated contact number, which is available twenty-four 24 hours a day/ seven 7 days a week, every day of the year

Classification of hospital Al Qassim cluster

• comprehesive stroke hospital 
• primary stroke hospital 
• Acute readay stroke hospital   

comprehesive stroke hospital : 

• king Fafad specialist hosopital

-will activate stroke code pathway include management 

-will admit the patient in  HASU  for more diagnosis and management depend on the police and guidelin 

-able to treat stroke patients with catheter -based procedures to remove blood clots 

primary stroke hospital :

• Burudah CentralHospital.
•  King Saud Hospital
• Alrass General Hospital

All primary Stroke Hospital will activate stroke code pathway include management and will admit the
patient in stroke unit for more diagnosis and management depend on the police and guideline.

Acute readay stroke hospital   :

• AL Badaya General Hospital.
•  AL Midhnab General Hospital.
• Bukayriyah General Hospital
• AL Asyah General Hospital.
• Riyadh Al Khabr Hospital
•  Uyun AlJawaa Hospital

All Acute Stroke Hospital will activate stroke code pathway include management and transfer the
patient for more management and investigation to CSH or Primary Stroke Hospitatl depend on qassim Health
Cluster distribution

Acute stroke chain of reference.

lab request

STAT CBC,Coagulation profile,KFT,LFT and cardiac enzymes 

stroke pathway 

TIME GOAL

Stroke KPIS:

1. Median time interval from door to physician <15 min
2. Median time interval from door to CAT scan<20 min
3. Median time interval from door to IV r-tPA<60 min
4. Percentage of acute stroke patients admitted directly to an acute stroke unit from ED or home>80%

Stroke pathway   

Stroke guideline

Criteria of stroke patient