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Primary Stroke Centers Provide Superior Care for Stroke Patients

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Updated August 28, 2009

Primary Stroke Centers Provide Superior Care for Stroke Patients
Photo © A.D.A.M.

Advances in the treatment of stroke led to the advent of the "primary stroke center," or a hospital where a group of medical professionals who specialize in stroke, work together to diagnose, treat, and provide early rehabilitation to stroke patients.

The concept was born after experts in the field realized that less than 5% of people with an acute stroke received t-PA, a medication that when given within three hours of the beginning of stroke symptoms can help dissolve stroke-causing blood clots. However, if given later, it can lead to serious bleeding in the brain.

Many barriers prevent patients from receiving this treatment, but a common one is a delayed diagnosis inside a busy emergency room. To address this, the Brain Attack Coalition (BAC) issued comprehensive guidelines for the diagnosis and treatment of acute strokes.

The following are the major recommendations by the BAC that hospitals must address in order to obtain primary stroke center status with the Joint Commission.

  • A CT scan or MRI scanner must be available 24 hours each day, and should be reserved for stroke patients within 25 minutes of being ordered
  • Access to neurosurgical services (access to a brain surgeon)
  • Laboratory tests of patients with acute stroke must be completed within 45 minutes of being ordered
  • A physician with expertise in interpreting CT or MRI studies must be available within 20 minutes of being asked to read a study
  • A written t-PA protocol must exist in the emergency department
  • The medical organization must have a declared and established commitment for acute stroke care
  • The hospital must have written acute stroke "clinical pathways" or "care maps"
  • An acute stroke team, including a physician and at least one other healthcare professional, must be available around the clock
  • Follow long-term stroke treatment outcomes, and design quality improvement activities
  • Emergency staff must have completed formal training in acute stroke treatments
  • The hospital must have a "stroke unit"
  • There must be a designated stroke center director
  • The stroke team must schedule stroke medical education sessions for stroke staff
  • The hospital must provide formal stroke training for ambulance personnel

Some important reasons why the above requirements make primary stroke centers the best places to obtain acute stroke care include the following:

Stroke centers provide methodical and organized stroke care

A common goal of each stroke center is to transport, assess, diagnose, and treat each stroke patient within three hours of the onset of their symptoms. To accomplish this, these specialized hospitals must have protocols in place in order to offer a well-orchestrated effort on behalf of each patient. Often, these protocols must be rehearsed and tested to ensure that the three-hour goal to treatment is accomplished. Some of the major tasks a primary stroke center is able to accomplish during this three-hour time window include:
  • Transport the patient to the hospital
  • Perform a full evaluation by a physician -- often a neurologist
  • Obtain and read, a CT scan of the brain
  • Draw blood, analyzing it, and reporting the results
  • Deliver appropriate treatment

Management of strokes by stroke specialists

Most stroke centers with a functional stroke unit have neurologists, or vascular neurologists (physicians who specialize in stroke) on staff, and very often they are in-house, around the clock. These physicians function under the motto "time is brain." Therefore, they are very speedy, but very accurate, at recognizing unusually dangerous strokes. When this happens, these physicians are trained to coordinate emergent surgeries, and to arrange rapid transfers to the intensive care unit, or to a more specialized hospital.

Appropriate recognition and management of stroke complications

Physicians and nurses who are a part of a stroke center are trained to recognize medical complications that can arise in someone who has suffered a stroke. This is extremely important, as stroke patients often worsen quickly within the first few hours or days after a stroke. In fact, even the mildest of strokes run a 10% risk of converting to larger ones in the first 48 hours.

Some of the complications that are common after a stroke include:

  • A new, or an expanding stroke
  • Bleeding, especially when treated with t-PA
  • Seizures
  • Brain swelling
  • Medical complications such as pneumonia and other infections

Ancillary staff is familiar with the needs of stroke patients

An important advantage of stroke centers is their connection with social workers and other ancillary staff members who are familiar with the short- and long-term needs of stroke patients. These trained professionals often provide major assistance in solving problems related to health insurance, in obtaining outpatient appointments with stroke physicians, psychologists, or occupational therapists, and in choosing the best rehabilitation places for a given patient's needs.

Patients treated in stroke units are more likely to recover

One of the most important reasons why primary stroke centers are the premier places for the treatment of strokes is that, by having specialized stroke units, these hospitals provide better results in the treatment of stroke when compared to hospitals that treat stroke patients in medical intensive care units, or through a "mobile in-hospital stroke team." Patients treated in stroke units have been shown to be more likely to be alive, independent, and living at home one year after their stroke.

Sources:

Stroke Unit Trialists' Collaboration. Organized inpatient (stroke unit) care for stroke. Cochrane database of Systematic Reviews 2007, Issue 4. Art. No.:CD000197. DOI: 10.1002/14651858.CD000197.pub2.

C. S. Kidwell, et al., Establishment of primary stroke centers: a survey of physician attitudes and hospital resources Neurology 2003;60:1452-1456.

Rajajee V et al.; Early MRI and outcomes of untreated patients with mild or improving ischemic stroke. Neurology. 2006 67(6):980-4.

Ali LK, Saver JL.; The ischemic stroke patient who worsens: new assessment and management approaches. Rev Neurol Dis 2007 Spring;4(2):85-91.

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