Recommendations for Comprehensive Stroke Centers

Abstract

for the Brain Attack CoalitionBackground and Purpose-To develop recommendations for the establishment of comprehensive stroke centers capable of delivering the full spectrum of care to seriously ill patients with stroke and cerebrovascular disease. Recommendations were developed by members of the Brain Attack Coalition (BAC), which is a multidisciplinary group of members from major professional organizations involved with the care of patients with stroke and cerebrovascular disease. Summary of Review-A comprehensive literature search was conducted from 1966 through December 2004 using Medline and Pub Med. Articles with information about clinical trials, meta-analyses, care guidelines, scientific guidelines, and other relevant clinical and research reports were examined and graded using established evidence-based medicine approaches for therapeutic and diagnostic modalities. Evidence was also obtained from a questionnaire survey sent to leaders in cerebrovascular disease. Members of BAC reviewed literature related to their field and graded the scientific evidence on the various diagnostic and treatment modalities for stroke. Input was obtained from the organizations represented by BAC. BAC met on several occasions to review each specific recommendation and reach a consensus about its importance in light of other medical, logistical, and financial factors. Conclusions-There are a number of key areas supported by evidence-based medicine that are important for a comprehensive stroke center and its ability to deliver the wide variety of specialized care needed by patients with serious cerebrovascular disease. These areas include: (1) health care personnel with specific expertise in a number of disciplines, including neurosurgery and vascular neurology; (2) advanced neuroimaging capabilities such as MRI and various types of cerebral angiography; (3) surgical and endovascular techniques, including clipping and coiling of intracranial aneurysms, carotid endarterectomy, and intra-arterial thrombolytic therapy; and (4) other specific infrastructure and programmatic elements such as an intensive care unit and a stroke registry. Integration of these elements into a coordinated hospital-based program or system is likely to improve outcomes of patients with strokes and complex cerebrovascular disease who require the services of a comprehensive stroke center. (Stroke. 2005;36:1597-1618.)

Bench to Bedside: The Quest for Quality in Experimental Stroke Research

“…As a result of this concept of acute stroke as a treatable disease with a very short therapeutic window, a network of dedicated stroke units has been established in many countries. A clear therapeutic benefit of stroke units has been demonstrated (Langhorne and Dennis, 2004;Alberts et al, 2005;Stroke Unit Trialists' Collaboration, 1997;Indredavik et al, 1999;Drummond et al, 2005). Advanced diagnostic imaging of stroke is now widely available, and includes early measures of damage (DWI) as well as blood perfusion (magnetic resonance (MR)-angiography, MR perfusion, computed tomography perfusion; Warach, 2003;Hjort et al, 2005).…”

Compliance with joint commission measures in state-designated stroke centers

“…The Brain Attack Coalition (BAC) proposed 2 levels of stroke hospitals: primary stroke centers (PSCs) and comprehensive stroke centers (CSCs). 3,4 Although most stroke patients can be cared for at PSCs, CSCs are able to care for more complex stroke patients. 4,5 Using BAC recommendations the Joint Commission (JC) and American Heart Association/American Stroke Association created a certification program for PSCs.…”

“…3,4 Although most stroke patients can be cared for at PSCs, CSCs are able to care for more complex stroke patients. 4,5 Using BAC recommendations the Joint Commission (JC) and American Heart Association/American Stroke Association created a certification program for PSCs. Eight evidence-based performance measures are currently required for JC PSC certification.…”

Effectiveness of regionalized systems for stroke and myocardial infarction

“…1994, 1996, 2003, 2005, 2007; The National Institute of Neurological Disorders and Stroke rt‐PA Stoke Study Group, 1995; Levine and Gorman 1999; Alberts et al. 2000, 2005, 2011, 2013; Albers et al. 2004; Schwamm et al.…”

“…2000) to provide the care that most patients would need, and comprehensive stroke centers (CSC) (Alberts et al. 2005) to provide more advanced stroke care. In 2003, the Joint Commission (JC) began to certify PSC based on these criteria.…”