Published online before print January 4, 2007, doi: 10.1161/01.STR.0000254945.58878.c5
(Stroke. 2007;38:225.)
© 2007 American Heart Association, Inc.
Advances in Stroke 2006 |
Critical Care and Emergency Medicine
From the Neurological Intensive Care Unit, Departments of Neurolgy and Neurosurgery, Columbia University Medical Center, New York, NY (S.A.M.); and the Department of Neurology, University of Erlangen, Erlangen, Germany (S.S.).
Correspondence to Stephan A. Mayer, MD, FCCM, Neurological Institute, 710 W 168th St, Box 39, New York, NY 10032. E-mail sam14@columbia.edu
Key Words: critical care • emergency medical services • emergency medicine
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
The emergency department (ED) and intensive care unit (ICU) are the frontlines in the battle against stroke. It has become increasingly clear that the efficacy of stroke therapy depends first and foremost on early intervention. However, this demanding race against time has overwhelmed many hospitals and emergency departments, creating new demands for rapid patient triage, imaging and monitoring that simply cannot be met. In 2006 a landmark study commissioned by the Institute of Medicine entitled "Hospital-Based Emergency Care: At the Breaking Point" detailed how understaffing, overcrowding, lack of resources and difficulties in obtaining specialist coverage have created a crisis in our emergency rooms.1 How to successfully integrate a new paradigm of ultra-emergent stroke care into this environment is a major challenge that will confront our field over the next decade.
Realizing that the very feasibility of acute stroke therapy depends on well-coordinated emergency care, a growing body of research has focused on designing more efficient methods for delivering acute stroke therapy to as many people as possible, as quickly as possible. At the same time, despite a growing literature documenting that victims of life-threatening neurological disease such as intracerebral hemorrhage and traumatic brain injury have better outcomes when cared for in dedicated neurological ICUs,2–5 a consensus statement by the Brain Attack Coalition on standards for Comprehensive Stroke Centers identified neurointensivists and dedicated neuro-ICUs as desirable, but optional.6 This likely speaks much more to practical considerations regarding the physician workforce and existing hospital infrastructures than what is truly best for patient
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