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Treating by numbers
  1. Timothy J Counihan1,2
    1. 1Department of Neurology, Galway University Hospitals, Galway, Ireland
    2. 2School of Medicine, National University of Ireland Galway.
    1. Correspondence to Dr Timothy J Counihan, Department of Neurology, Galway University Hospitals, Galway, H91 YR71, Ireland; timothy.counihan{at}hse.ie

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    Registrar: ‘Hello, am I speaking with the consultant neurologist on-call?’

    Consultant: ‘Regrettably! Yes that’s me. What is it?’

    R: ‘Hi this is Dr Richter, medical reg. on call. Sorry to disturb you so late, but we’ve got a FAST1 positive in A&E.’

    C: ‘A what?’

    R: ‘A FAST-positive patient.’

    C: ‘I assume that’s worse than a FAST-negative patient then. Go on.’

    R: ‘Well the NIHSS2 is 24 but her GCS3 4 is 12 currently. Before we got the CT, I was worried about a subarachnoid, because her Hunt & Hess5 was 4.’

    C: ‘Gosh.’

    R: ‘But thankfully the CT showed no bleed, but the ASPECTS6 was 6.’

    C: ‘Six, did you say? That doesn’t sound too bad. At least it’s not 10 or something.’

    R: ‘Actually 10 is a normal score. You really don’t want an ASPECTS lower than 6.’

    C: ‘I see. So what are you recommending to do?’

    R: ‘Well, time is brain, Professor, and I think it would be good to keep our door-to-needle stats …

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    • Editors’ commentary
      Philip E M Smith Geraint N Fuller