Patients, Centres, Admission Procedures and Non-Randomized Treatments around the World

Abstract

There are intensive international efforts to test promising interventional therapies for ischaemic stroke. National differences in accrual, management and consent could impact on international stroke trials. Information was sought from stroke investigators in 20 countries concerning stroke rates and hospitalization, trial centres, arrival times and triage, neurological involvement and stroke units, consent protocols and use of unproven stroke therapies. Except in developing nations, most patients are hospitalized. Neurologists rarely care for stroke patients and there are few stroke units, despite their proven value. Delays in hospital arrival and triage are common. However, in some countries, most patients arrive within acute trial time windows. Surrogate trial consent is generally accepted, but is under threat and will reduce accrual of patients with aphasia and depressed conscious state. Prevalent unproven acute therapies include heparin, aspirin and glycerol. Stroke trials networks could increase accrual and coordination of acute therapy trials.