We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Letters |

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

Phil B. Fontanarosa, MD; Margaret A. Winker, MD
JAMA. 1999;281(1):31-34. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-1-jbk0106.
Text Size: A A A
Published online


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.


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.