Members of the Brain Attack Coalition, a multidisciplinary group of representatives from major professional organizations involved with delivering stroke care, yesterday published a new set of recommendations for establishing and operating primary care stroke centers.
"I think this is a significant step forward in care for stroke patients nationwide," said Dr. Mark Alberts, the study's lead author and an associate professor of neurology.
In an article in the most recent edition of the Journal of the American Medical Association, the group presented the results of their study, which reviewed more than 600 MEDLINE articles.
The articles, ranging in publication dates from 1966 to 2000, presented evidence from randomized clinical trials, care guidelines, meta-analyses and other proposals for treating patients with acute stroke.
After an initial review of the selected articles, Alberts and his team submitted a list of recommendations to the coalition. The BAC discussed each recommendation and reached a consensus before adding it to the final list.
"Studies have shown that if you're going to do a good job in treating stroke patients, there are two things that make a difference: time and expertise," said Alberts. "If patients can be rapidly treated and with expertise, it will help a lot."
BAC officials hope that establishing stroke centers will allow hospitals to do just that.
Alberts added that many hospitals, including Duke, already have stroke centers in place, while others are close to creating their own.
"In one recent study, 66 percent of hospitals surveyed did not have stroke protocols and 82 percent did not have rapid identification for patients experiencing acute stroke," the team wrote in the article.
The team found that key elements for improving patient care in stroke centers include the existence of acute stroke teams, stroke units, written care protocols and an integrated response system.
Necessary support services include the availability and interpretation of computed tomography scans 24 hours a day as well as the availability of rapid laboratory testing.
The team also found that administrative support, strong leadership and continuing education of the staff are important factors in a primary stroke center's success.
While the team was clear that trauma and stroke centers should follow different models, it also used the existing model of a trauma center to illustrate some of its recommendations.
"The trauma center concept grew in part due to the high number of avoidable deaths in patients who experience trauma," the article reports. "A similar situation may be present in patients with acute stroke, in that many patients do not receive effective treatments for a variety of reasons."
Alberts explained that there are pressing reasons for establishing stroke centers.
"Stroke is an exceedingly common disease, a third leading cause of death and [costs an] estimated $50 billion a year," he said.
Additionally, the group cited 750,000 as the estimated number of new and recurrent strokes in the United States each year.
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