on June 16, 2005
Published online before print June 16, 2005, doi: 10.1161/01.STR.0000170622.07210.b4
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Submitted on January 5, 2005
From the Department of Radiology (R.E.L.), University of California at Davis, Sacramento; Department of Neurosurgery (W.R.S.), University Hospitals of Cleveland, Ohio; Neuroscience Consultants (T.S.), Richmond, Va; Department of Neurosurgery (M.N.H.), University of Alabama at Birmingham; Neurology Service (L.B.), VA Connecticut Healthcare System, New Haven; Neurology Service (W.K.), Massachusetts General Hospital, Boston; National Institute of Neurological Diseases and Stroke (J.R.M., M.E., M.W., M.D.W.), Bethesda, Md; The Office of the National Director of Neurology of the Department of Veterans Affairs (J.B.), West Haven, Conn; Department of Physical Medicine and Rehabilitation (R.Z.), University of Pennsylvania, Philadelphia; Miami Cardiac and Vascular Institute (J.J.C.III), Florida; Centers for Disease Control and Prevention (J.C.), Atlanta, Ga; American Stroke Association (E.M.), Dallas, Tex; National Stroke Association (D.M.), Englewood, Colo; Department of Emergency Medicine (A.J.), Mt. Sinai School of Medicine, New York, NY; Christiana Care Health System (R.O.), Newark, Del; Department of Neurosurgery (M.C.), Emory University, Atlanta, Ga; and OSF Saint Francis Medical Center (J.A.R.-D.), Peoria, Ill. * To whom correspondence should be addressed. E-mail: m-alberts{at}northwestern.edu.
Background 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.
Accepted on February 8, 2005
Recommendations for Comprehensive Stroke Centers. A Consensus Statement From the Brain Attack Coalition
Mark J. Alberts MD*;
Key words: cerebrovascular disorders • cerebral hemorrhage • healthcare systems • patient care • university medical centers
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