Recommendations for the establishment of primary stroke centers

Objective To develop recommendations for the establishment and operation of primary stroke centers as an approach to improve the medical care of patie nts with stroke. Participants Members of the Brain Attack Coalition (BAC), a multidisciplina ry group of representatives from major professional organizations involved with delivering stroke care. Supplemental input was obtained from other exp erts involved in acute stroke care. Evidence A review of literature published from 1966 to March 2000 was perfo rmed using MEDLINE. More than 600 English-language articles that had eviden ce from randomized clinical trials, meta-analyses, care guidelines, or othe r appropriate methods supporting specific care recommendations for patients with acute stroke that could be incorporated into a stroke center model we re selected. Consensus Process Articles were reviewed initially by 1 author (M.J.A.). Me mbers of the BAC reviewed each recommendation in the context of current pra ctice parameters, with special attention to improving the delivery of care to patients with acute stroke, cost-effectiveness, and logistical issues re lated to the establishment of primary stroke centers. Consensus was reached among all BAC participants before an element was added to the list of reco mmendations. Conclusions Randomized clinical trials and observational studies suggest th at several elements of a stroke center would improve patient care and outco mes. Key elements of primary stroke centers include acute stroke teams, str oke units, written care protocols, and an integrated emergency response sys tem. Important support services include availability and interpretation of computed tomography scans 24 hours everyday and rapid laboratory testing. A dministrative support, strong leadership, and continuing education are also important elements for stroke centers. Adoption of these recommendations m ay increase the use of appropriate diagnostic and therapeutic modalities an d reduce peristroke complications. The establishment of primary stroke cent ers has the potential to improve the care of patients with stroke.