title: Recommendations for comprehensive stroke centers: a consensus statement from the Brain Attack Coalition.
abstract: 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.
authors.affiliation: Northwestern University Medical School, 710 N Lake Shore Dr, Room 1420, Chicago, IL 60611, USA. m-alberts@northwestern.edu
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Alberts
authors.forename: Richard E
authors.initials: RE
authors.lastname: Latchaw
authors.forename: Warren R
authors.initials: WR
authors.lastname: Selman
authors.forename: Timothy
authors.initials: T
authors.lastname: Shephard
authors.forename: Mark N
authors.initials: MN
authors.lastname: Hadley
authors.forename: Lawrence M
authors.initials: LM
authors.lastname: Brass
authors.forename: Walter
authors.initials: W
authors.lastname: Koroshetz
authors.forename: John R
authors.initials: JR
authors.lastname: Marler
authors.forename: John
authors.initials: J
authors.lastname: Booss
authors.forename: Richard D
authors.initials: RD
authors.lastname: Zorowitz
authors.forename: Janet B
authors.initials: JB
authors.lastname: Croft
authors.forename: Ellen
authors.initials: E
authors.lastname: Magnis
authors.forename: Diane
authors.initials: D
authors.lastname: Mulligan
authors.forename: Andrew
authors.initials: A
authors.lastname: Jagoda
authors.forename: Robert
authors.initials: R
authors.lastname: O'Connor
authors.forename: C Michael
authors.initials: CM
authors.lastname: Cawley
authors.forename: J J
authors.initials: JJ
authors.lastname: Connors
authors.forename: Jean A
authors.initials: JA
authors.lastname: Rose-DeRenzy
authors.forename: Marian
authors.initials: M
authors.lastname: Emr
authors.forename: Margo
authors.initials: M
authors.lastname: Warren
authors.forename: Michael D
authors.initials: MD
authors.lastname: Walker
mesh_terms: 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*