Which proportion of your ischaemic strokes in the last twelve months were TOAST classified as cardioembolic versus large vessel disease? Of those, what percentage arrived within the thrombolysis window? What was the median ASPECTS score in patients who received thrombectomy? These are the audit questions that quality improvement committees ask and that only a structured registry can answer.
Risk Factor and Onset Data
HTN, DM, TIA, Stroke, IHD, AF, RHD, Lipids, OCP, FH, Smoking, Alcohol, and Others are the vascular risk factor fields — the epidemiological profile that determines the pre-stroke risk burden. AF and RHD are the specific risk factors associated with cardioembolic stroke; their presence alongside a TOAST classification of cardioembolic validates the categorization. TIA history in a new stroke patient raises specific acute management considerations — prior TIA within 48 hours is a high-risk presentation regardless of symptom duration.
DOA (date of admission), Duration of symptoms, and Delay from onset to presentation capture the time-critical data that determines thrombolysis eligibility. Symptom duration beyond 4.5 hours closes the IV thrombolysis window in most protocols. The delay field — time from symptom onset to hospital arrival — is the modifiable gap that stroke awareness campaigns target and that audit data validates or refutes.
Neurological Examination Profile
Headache, Vomiting, Seizure, Dizziness, Confusion are the presenting complaint fields. Weakness, Numbness, Speech, Vision, Balance, Altered, Cognitive capture the symptomatic neurological deficits. Aphasia, Dysarthria, Hemiparesis, Sensory, Hemianopia, Longtract, Cerebellar, Gait, Dysphagia, and Ocular are the examination findings — the structured neurological deficit inventory.
The granularity of the deficit fields reflects the clinical purpose of the registry. NIHSS scoring covers the major domains, but the structured field approach allows deficit combination analysis — for example, identifying patients with isolated aphasia versus those with combined hemispheric syndromes — that the summary score alone doesn't provide.
Severity Scores and Classification
NIHSS (NIH Stroke Scale) quantifies the neurological deficit at presentation — the number that predicts outcome probability and determines treatment intensity. ASPECTS (Alberta Stroke Program Early CT Score) quantifies early ischaemic change on CT — the 10-point score where a score below 6 in major artery territory generally predicts poor functional outcome with reperfusion therapy. MRS (Modified Rankin Scale) documents functional outcome — the disability measure that becomes the primary endpoint in stroke trials and audits.
TOAST classifies the stroke mechanism: large artery atherosclerosis, cardioembolism, small vessel occlusion, other determined, undetermined. The mechanism classification drives secondary prevention — anticoagulation for cardioembolic, antiplatelet and statin for atherosclerotic, BP control for small vessel.
MRI, MRA, CT, CTA, DSA are the imaging modalities recorded — which imaging was performed and available for the clinical decision-making. In centres with MRI-first protocols versus CT-first protocols, the imaging field distribution reflects institutional practice variation that the registry makes quantifiable across the patient cohort.