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(Stroke. 2005;36:2344-a.)
© 2005 American Heart Association, Inc.

Letters to the Editor

Is Neurointensive Care Really Optional for Comprehensive Stroke Care?

J. Claude Hemphill, III, MD; Thomas Bleck, MD; J. Ricardo Carhuapoma, MD; Cherylee Chang, MD; Michael Diringer, MD; Romergryko Geocadin, MD; Stephan Mayer, MD; Owen Samuels, MD Paul Vespa, MD

on behalf of the Neurocritical Care Society Minneapolis, Minn

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

To the Editor:

Expertise matters. The recent recommendations for Comprehensive Stroke Centers (CSC) put forth by the Brain Attack Coalition (BAC) make this argument convincingly using consensus and medical evidence when available.¹ This document represents a landmark in advancing the care of stroke patients and will likely have important policy implications for hospitals, administrators, and regulatory agencies in planning for identification, certification, and management of CSCs. Certainly, this has been the case for the certification of Primary Stroke Centers recently implemented by the Joint Commission on Accreditation of Healthcare Organizations.

Given the important implications of the CSC recommendations, it is unfortunate that the BAC has actually created recommendations that encourage less than comprehensive care for critically ill stroke patients, placing them at risk for less favorable outcomes. Specifically, the BAC has designated neuroscience intensive care units (NICU) and neurointensivists as optional components of a Comprehensive Stroke Center. Moreover, with no supporting evidence referenced, they have indicated that hiring a neurointensivist (and presumably developing an NICU) is likely associated with significant institutional cost. Some hospital administrators would likely see this as a BAC-sanctioned opportunity to reduce the availability of neurointensivists and NICUs (including specially trained neurocritical care nurses) because they will be perceived as costly and optional for certification. Thus, the BAC has created recommendations that may well have a real and potentially dangerous impact on stroke patients.

Why is this a bad idea? Several studies have shown that, in fact, neurointensivists and NICUs save lives and improve the outcome of . . . [Full Text of this Article]