The AANS announced in June its support of a plan to establish Primary Care Stroke Centers. The need for such centers was detailed in a research paper written by members of the Brain Attack Coalition for the Journal of the American Medical Association (JAMA) on June 21. The AANS is a member of the coalition.
In the JAMA article the Brain Attack Coalition presented the first clearly defined set of recommendations for hospitals to implement stroke centers, teams and other programs to improve stroke treatment in the United States. Strokes require immediate treatment to help prevent death and disability, but many hospitals do not yet have the infrastructure and organization necessary to triage and treat stroke patients in the rapid manner required to get maximum benefit.
Despite significant advances in the diagnoses, treatment and prevention of stroke, it remains a common disorder. Recent studies suggest there may be as many as 750,000 new and recurrent strokes each year in the United States. Stroke is the third leading cause of death and a leading cause of adult disability in the United States. Direct costs for medical care and therapy for stroke are estimated at $30 billion a year.
Mark J. Alberts, MD, lead author of the JAMA paper, said, “Our recommendations are similar to those guiding trauma centers-getting patients to facilities where the specialists and infrastructure are in place to evaluate and treat them quickly. If facilities can put together the resources to treat trauma patients, why can’t they do the same for stroke patients?” Dr. Alberts is also chairman of the Stroke Belt Consortium and director of the stroke acute care unit at Duke University Medical Center.
The paper emphasized the important role of Acute Stroke Teams, emergency departments, stroke units and the short window of opportunity that stroke victims have for receiving crucial medical attention.
The recommendations were announced at a press conference June 20 in Washington, D.C. The AANS Communications staff worked with the National Institutes of Health (NIH) to draft press releases and fact sheets and provided on-site assistance during the press conference
The press event received extraordinary media attention. Covering the event were CNN, ABC, NBC, Reuters Health, CBS Radio, Hearst Television, HealthScout, CBS Healthwatch and WebMD.
Marc Mayberg, MD, a co-author of the study, served as a spokesperson representing the field of neurosurgery at the press conference. Dr. Mayberg emphasized the importance of a patient receiving treatment from a medical professional who has stroke expertise. Doctors have five minutes to evaluate the reason for the stroke and a few hours to treat it before the patient dies or suffers permanent damage.
Improving the Level of Care
The two major goals of the stroke center recommendations are the improvement in the level of care for stroke patients and the standardization of some aspects of acute care for the patients.
“These recommendations are a perfect example of what the Brain Attack Coalition came together to do-develop ways to reduce the death and disability caused by stroke,” said Michael D. Walker, MD, the Coalition’s chair and former director of stroke, trauma and neurodegenerative disorders at the National Institute of Neurological Disorders and Stroke at the National Institutes of Health. “Our paper offers a way for hospitals to significantly improve outcomes for stroke patients by dedicating the resources necessary to diagnose and treat stroke patients within the critical three-hour time period.”
The Brain Attack Coalition is a group of professional, voluntary and government organizations whose mission is to reduce the occurrence, disabilities and death associated with stroke. Its goal is to strengthen and promote the relationship among the member organizations: the AANS, the American Aca-demy of Neurology, the American Association of Neuroscience Nurses, the American Stroke Assocciation (a division of the American Heart Association), the American Society of Neuroradiology, the Congress of Neurological Surgeons, the National Institute of Neurological Disorders and Stroke, the National Stroke Association and the Stroke Belt Consortium.
See Establishing a Primary Stroke Center for the Brain Coalition’s complete recommendations for establishing primary stroke centers.
Establishing a Primary Stroke Center
The Brain Attack Coalition, a group of professional, voluntary and government organizations whose mission is to reduce the occurrence, disabilities and death associated with stroke, has published the following recommendations for establishing primary stroke centers:
Acute Stroke Teams
The Acute Stroke team should include a physician with experience in diagnosing and treating cerebrovascular disease and one other healthcare provider as a minimum. Hospital-based stroke teams should be available at all times in order to evaluate within 15 minutes any patient who may have suffered a stroke.
Written Care Protocols
Hospitals should have written procedures to streamline and accelerate the diagnosis and treatment of stroke patients.
Emergency Medical Services
EMS have a vital role in the rapid transportation and survival of stroke patients. Effective communication between hospitals and EMS is a cornerstone of a Primary Stroke Center.
Emergency Department
The emergency department staff should have training in diagnosing and treating stroke and have good lines of communication with both EMS and the acute stroke team.
Stroke Unit
A Primary Stroke Center wishing to provide care beyond the initial life-threatening period should have access to a Stroke Unit where patients can receive specialized monitoring and care.
Neurosurgical Services
Primary Stroke Centers should be able to provide neurological services to stroke patients within two hours of when the services are deemed necessary.
Support of Medical Organization
The facility and its staff, including administration, should be committed to the Primary Stroke Center.
Neuroimaging
The ability to perform brain imaging studies, including CT scans, on stroke patients is vital for physicians to make a fast, accurate diagnosis. The imaging study should be done within 25 minutes of the physician’s order and the image should be evaluated by a physician within 20 minutes of completion.
Laboratory Services
Standard laboratory services should be available at all times. These services include rapidly performing and reporting blood counts, blood chemistries and coagulation studies and obtaining ECG and chest x-rays.
Educational Programs
The professional staff of a Primary Stroke Center should receive at least eight hours per year of continuing medical education credit. They also should present at least two annual programs to educate the public about stroke. Physicians should treat stroke patients within a few hours to prevent permanent damage to the patient.
Get ALL THE Guidelines
To receive a copy of the recommendations and/or the JAMA article, email your request to [email protected]. The press materials have also been posted on our Web site at:www.neurosurgery.org/aans/media
Heather Monroe is the AANS director of communications.