EUROPEAN STRATEGIES FOR EARLY INTERVENTION IN STROKE - A REPORT OF ANAD-HOC CONSENSUS GROUP MEETING

Stroke is a major cause of death and disability in industrialized coun tries, but stroke awareness is still generally poor and treatment ofte n ill-defined. At a meeting of a European Ad Hoc Consensus Group, the following recommendations for acute stroke management were made. Need for education: There is a clear need for stroke awareness to be increa sed. Use of the terms 'brain attack' and 'brain infarction', appropria tely translated into the major European languages, can aid this proces s. The major target groups for educational programmes should be the pu blic, particularly those at risk and their spouses and relatives, and paramedical staff. Media campaigns that inform the public what to do a nd where to go/contact if a stroke occurs could significantly reduce t he time to presentation. Acute stroke care should not be promoted too aggressively or prematurely before an adequate infrastructure is in pl ace to successfully administer modern evidence-based therapies. Organi zation of acute stroke care: Stroke is a medical emergency. A stroke u nit offers the most effective acute stroke care in terms of both morta lity and short- and long-term morbidity, and may thereby both improve outcome and lower costs. A stroke team is an acceptable alternative in areas where a dedicated stroke unit is not available. Optimal acute s troke care: General guidelines should be provided on the flow of decis ion-making and urgent care, with specific instructions for each stage and event in acute stroke. It is essential that all stroke patients ar e admitted to hospital quickly, ideally within the first 1-2 h. Ways m ust be established to reduce transition times within the local setting when patients and/or emergency services contact a variety of differen t physicians and hospitals. The minimum emergency investigations neces sary for differential diagnosis of stroke are computed tomography (CT) , Doppler ultrasonography, electrocardiography (ECG) and blood tests. These must be available 24 h/day and be performed without delay. Gener al medical measures should be instituted as necessary, even before CT scanning, with reference to the potential particular complications of acute stroke. Acute stroke patients should be monitored continuously o r at frequent intermittent intervals throughout the first 24 h with re spect to blood pressure, ECG, respiration, temperature and oxygen satu ration. In carefully selected patients, thrombolysis with recombinant tissue plasminogen activator (rt-PA) may be indicated (if approved by regional registration agencies). This must be administered under speci alist supervision, and on a dedicated intensive care or intensive stro ke care unit. Careful selection of eligible patients is paramount. Thr ombolysis with streptokinase is not recommended, due to the excessive risk of haemorrhage. If these measures and early secondary prevention are implemented, it will be possible to improve stroke outcome and red uce the cost of acute and chronic stroke care. New agents for acute st roke treatment, e.g. the neuroprotectants currently being evaluated in phase III trials, should also contribute to improved outcomes.