The South London Stroke Register: Improving the Lives of Stroke Survivors With Data

The South London Stroke Register is a long-running population-based stroke register including all patients with first stroke occuring in a defined area of London. The study area comprises 27 electoral wards in the Northern part of Lambeth and Southwark and participant's residence within these wards is confirmed by postcode.

Information on the population denominator, including sociodemographic details of the catchment area, is obtained through the ONS.

Notification for SLSR has been ongoing since 1st January 1995 and uses multiple overlapping sources of notification, but more recently focussing on notification sources in hospitals, in line with the evolution and reorganisation of the stroke care pathway. Since the centralisation of London stroke services in 2010, all suspected stroke patients are taken by ambulance to one of 8 hyper acute stroke units. These units provide 24/7 access to specialist care and evidence based treatment to admitted patients. Notification sources for the new data collection will include these hyper acute stroke units, stroke units, outpatient stroke clinics, radiology and other relevant wards. Stroke patients presenting anywhere in the health service including A&E departments or GP surgeries should be identifiable from these sources.

The study will use 8 hospital centres: Primary sites at St Thomas' and King's College Hospitals and secondary sites at St George's, Charing Cross, Royal London, Princess Royal University, University College London, and Chelsea and Westminster hospitals. Primary sites are hospitals within the boundaries of the study area. According to the current service organisation they should receive all patients resident within the study area. King's College Hospital has both a hyper acute stroke unit and a stroke unit, while St Thomas' has a stoke unit only. Both sites have run 'Transient Ischaemic Attack (TIA) clinic', which is an acute/urgent referral service largely from A+E and primary care for the assessment of people with transient neurological symptoms or late presentation of stroke. These units and clinics will serve as primary notification sources. Patients living near the boundaries of the study area may be admitted to hospitals outside the district and the ambulance system may occasionally take patients to outlying hospitals. These patients will normally be repatriated to the stroke units at their local hospitals (the primary sites) and in many cases could be notified from there. The inclusion of relevant hospitals as secondary sites will ensure capture of the few cases who will be discharged home directly rather than repatriated.

Study teams will visit the hyper acute stroke unit at King's College Hospital and the stroke units at both hospitals and review electronic patient records daily during the working week. Outpatient stroke clinics take place twice weekly at both hospitals. Study teams will visit the clinics and screen patient records to identify mild stroke patients (including those formerly classed as TIAs) not captured at the hyper acute unit and stroke units. This will be a key site for notification of lower risk events, which are not typically referred to stroke units.