Reducing Treatment Delay and Improving Diagnostic Accuracy for Patients With Acute Stroke—Reply

In Reply: Dr Campa and Dr Palma express concerns similar to those raised in our Editorial: how to achieve the optimal balance between reducing time to initiation of acute treatment for patients with stroke and how to minimize the likelihood of adverse events from therapy.

We agree with Campa that all physicians involved in decision making regarding therapeutic interventions for patients with acute stroke should have training and expertise in interpretation of neuroimaging studies as well as with the clinical examination and management of patients with acute neurologic conditions. Neurologists play a critical role in the management of patients with stroke, and their prompt availability and early involvement have been shown to be related to better functional outcomes and shorter hospitalizations.¹ Indeed, in proceedings from a National Institutes of Health–sponored symposium, Grotta² recommends that the components of a primary stroke center should include a stroke team, with "a neurologist or other physician with stroke expertise on call within 15 minutes, either on site or by telemedicine." However, in 2 previous studies of patients with stroke, the mean time from the patient's arrival in the emergency department until evaluation by a neurologist was reported to be 123 minutes³ and 3.6 hours.⁴ Such delays, especially if coupled with delays in obtaining a CT scan, could reduce the efficacy of thrombolytic therapy, even if patients arrive at the hospital soon after symptom onset.