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Definitions

Hyperacute and Acute Stroke care involves all direct care, service delivery and interactions from first contact with the healthcare system after the onset of an acute stroke to discharge from an emergency department or acute inpatient care, and moving on to the next stage of care or return to the community.

Hyperacute stroke care refers to the key interventions involved in the assessment, stabilization and treatment in the first hours after stroke onset. This represents all pre-hospital and initial emergency care for TIA, ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage and acute venous sinus thrombosis.  This includes thrombolysis or endovascular interventions for acute ischemic stroke, emergency neurosurgical procedures, and same-day TIA diagnostic and risk stratification evaluation.

The principal aim of this phase of care is to diagnose the stroke type, and to coordinate and execute the treatment plan as rapidly as possible.

Hyperacute care is time-sensitive by nature, minutes for disabling stroke and hours for TIA, but specific interventions are associated with their own individual treatment windows. Broadly speaking ”hyperacute” refers to care offered in the first 24 hours after stroke (ischemic and hemorrhagic) and the first 48 hours after TIA.

Acute stroke care refers to the key interventions involved in the assessment, treatment or management, and early recovery in the first days after stroke onset. This will represent all of the initial diagnostic procedures undertaken to identify the nature and mechanism of stroke, interprofessional care to prevent complications and promote early recovery, institution of an individualized secondary prevention plan, and engagement with the stroke survivor and family to assess and plan for transition to the next level of care (including a comprehensive assessment of rehabilitation needs). New models of acute ambulatory care such as rapid assessment TIA and minor stroke clinics or day-units are also starting to emerge.

The principal aims of this phase of care are to identify the nature and mechanism of stroke, prevent further stroke complications, promote early recovery, and (in the case of severest strokes) provide palliation or end-of-life care.

Broadly speaking “acute care” refers to the first days to weeks of inpatient treatment with stroke survivors transitioning from this level of care to either inpatient rehabilitation, community based rehabilitation services, home (with or without support services), continuing care, or palliative care. This acute phase of care is usually considered to have ended either at the time of acute unit discharge or by 30 days of hospital admission.