Objective To develop recommendations for the establishment and operation of primary
stroke centers as an approach to improve the medical care of patients with
Participants Members of the Brain Attack Coalition (BAC), a multidisciplinary group
of representatives from major professional organizations involved with delivering
stroke care. Supplemental input was obtained from other experts involved in
acute stroke care.
Evidence A review of literature published from 1966 to March 2000 was performed
using MEDLINE. More than 600 English-language articles that had evidence from
randomized clinical trials, meta-analyses, care guidelines, or other appropriate
methods supporting specific care recommendations for patients with acute stroke
that could be incorporated into a stroke center model were selected.
Consensus Process Articles were reviewed initially by 1 author (M.J.A.). Members of the
BAC reviewed each recommendation in the context of current practice parameters,
with special attention to improving the delivery of care to patients with
acute stroke, cost-effectiveness, and logistical issues related to the establishment
of primary stroke centers. Consensus was reached among all BAC participants
before an element was added to the list of recommendations.
Conclusions Randomized clinical trials and observational studies suggest that several
elements of a stroke center would improve patient care and outcomes. Key elements
of primary stroke centers include acute stroke teams, stroke units, written
care protocols, and an integrated emergency response system. Important support
services include availability and interpretation of computed tomography scans
24 hours everyday and rapid laboratory testing. Administrative support, strong
leadership, and continuing education are also important elements for stroke
centers. Adoption of these recommendations may increase the use of appropriate
diagnostic and therapeutic modalities and reduce peristroke complications.
The establishment of primary stroke centers has the potential to improve the
care of patients with stroke.