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(Stroke. 2004;35:365.)
© 2004 American Heart Association, Inc.

Advances in Stroke 2003

Critical Care and Emergency Medicine Neurology

Daniel F. Hanley, MD Werner Hacke, MD

From Johns Hopkins University Department of Neurology (D.F.H.), Brain Injury Outcomes and Neurosciences Critical Care Divisions, Johns Hopkins Medical Institutions, Baltimore, Md; and the Department of Neurology (W.H.), Ruprecht-Karls-Universität Heidelberg, Germany.

Correspondence to Daniel F. Hanley, MD, Johns Hopkins Medical Institutions, 600 N Wolfe St, Jefferson 1-109, Baltimore, MD 21287. E-mail dhanley@jhmi.edu

Key Words: Advances in Stroke • critical care • emergency medical services

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Emergency Treatment of Stroke

The past year was highlighted by the implementation of the Paul Coverdell Stroke Registry. This is the first American national effort to assess and facilitate use of recombinant tissue plasminogen activator (rtPA) in the treatment of stroke by promoting quality improvement.¹ The registry goal is to reduce the disability associated with stroke. This effort is substantially later than similar efforts in many other developing countries.² For example, in Europe, the SITS-MOST registry, required by the European authorities in connection with the conditional approval of rtPA, is actively recruiting patients treated within 3 hours after stroke onset will test the effectiveness of regionalized stroke care across >200 sites in 26 countries.³ Recognition that benefits of early, coordinated interventions for the stroke survivor are achievable has been slow in the United States, but overall the evidence from this year’s scientific publications is that barriers to widespread community implementation of effective stroke treatment can be overcome.⁴

Public and medical system education can change the use of emergency treatment pathways for stroke with >50% of patients reporting in <3 hours in some systems.^5,6 Thus, the major barrier to widespread achievement of emergency stroke treatment is acceptance by the medical community. Implementing successful stroke center programs in the United States has now been reported in Cuyahoga County, the Kansas City region, and in a community setting in Maryland.^7–9 Organized emergency medicine publicly demonstrated reluctance to endorse regional stroke center utilization or the standard use of rtPA for the indicated.¹⁰ The major basis for this disagreement . . . [Full Text of this Article]

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