Recommendations for comprehensive stroke centers: a consensus statement from the Brain Attack Coalition.
OBJECTIVE
To develop recommendations for the establishment of comprehensive stroke centers capable of delivering the full spectrum of care to seriously ill patients with stroke and cerebrovascular disease. Recommendations were developed by members of the Brain Attack Coalition (BAC), which is a multidisciplinary group of members from major professional organizations involved with the care of patients with stroke and cerebrovascular disease.


RESULTS
A comprehensive literature search was conducted from 1966 through December 2004 using Medline and Pub Med. Articles with information about clinical trials, meta-analyses, care guidelines, scientific guidelines, and other relevant clinical and research reports were examined and graded using established evidence-based medicine approaches for therapeutic and diagnostic modalities. Evidence was also obtained from a questionnaire survey sent to leaders in cerebrovascular disease. Members of BAC reviewed literature related to their field and graded the scientific evidence on the various diagnostic and treatment modalities for stroke. Input was obtained from the organizations represented by BAC. BAC met on several occasions to review each specific recommendation and reach a consensus about its importance in light of other medical, logistical, and financial factors.


CONCLUSIONS
There are a number of key areas supported by evidence-based medicine that are important for a comprehensive stroke center and its ability to deliver the wide variety of specialized care needed by patients with serious cerebrovascular disease. These areas include: (1) health care personnel with specific expertise in a number of disciplines, including neurosurgery and vascular neurology; (2) advanced neuroimaging capabilities such as MRI and various types of cerebral angiography; (3) surgical and endovascular techniques, including clipping and coiling of intracranial aneurysms, carotid endarterectomy, and intra-arterial thrombolytic therapy; and (4) other specific infrastructure and programmatic elements such as an intensive care unit and a stroke registry. Integration of these elements into a coordinated hospital-based program or system is likely to improve outcomes of patients with strokes and complex cerebrovascular disease who require the services of a comprehensive stroke center.
Alberts
Mark J
MJ
Northwestern University Medical School, 710 N Lake Shore Dr, Room 1420, Chicago, IL 60611, USA. m-alberts@northwestern.edu
Latchaw
Richard E
RE
Selman
Warren R
WR
Shephard
Timothy
T
Hadley
Mark N
MN
Brass
Lawrence M
LM
Koroshetz
Walter
W
Marler
John R
JR
Booss
John
J
Zorowitz
Richard D
RD
Croft
Janet B
JB
Magnis
Ellen
E
Mulligan
Diane
D
Jagoda
Andrew
A
O'Connor
Robert
R
Cawley
C Michael
CM
Connors
J J
JJ
Rose-DeRenzy
Jean A
JA
Emr
Marian
M
Warren
Margo
M
Walker
Michael D
MD
D000046:Academic Medical Centers; D002543:Cerebral Hemorrhage / Q000628:therapy; D002561:Cerebrovascular Disorders / Q000628:therapy*; D002985:Clinical Protocols; D003422:Critical Care; D003695:Delivery of Health Care; D003952:Diagnostic Imaging; D004502:Education, Medical, Continuing; D004632:Emergency Medical Services; D006287:Health Planning Guidelines; D006748:Hospital Departments / Q000458:organization & administration*; D006782:Hospitals, Special / Q000458:organization & administration*; D006801:Humans; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D012046:Rehabilitation; D020521:Stroke / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy*