title: Revised and updated recommendations for the establishment of primary stroke centers: a summary statement from the brain attack coalition.
abstract: OBJECTIVE
  The formation and certification of Primary Stroke Centers has progressed rapidly since the Brain Attack Coalition's original recommendations in 2000. The purpose of this article is to revise and update our recommendations for Primary Stroke Centers to reflect the latest data and experience.
  
  
  METHODS
  We conducted a literature review using MEDLINE and PubMed from March 2000 to January 2011. The review focused on studies that were relevant for acute stroke diagnosis, treatment, and care. Original references as well as meta-analyses and other care guidelines were also reviewed and included if found to be valid and relevant. Levels of evidence were added to reflect current guideline development practices.
  
  
  RESULTS
  Based on the literature review and experience at Primary Stroke Centers, the importance of some elements has been further strengthened, and several new areas have been added. These include (1) the importance of acute stroke teams; (2) the importance of Stroke Units with telemetry monitoring; (3) performance of brain imaging with MRI and diffusion-weighted sequences; (4) assessment of cerebral vasculature with MR angiography or CT angiography; (5) cardiac imaging; (6) early initiation of rehabilitation therapies; and (7) certification by an independent body, including a site visit and disease performance measures.
  
  
  CONCLUSIONS
  Based on the evidence, several elements of Primary Stroke Centers are particularly important for improving the care of patients with an acute stroke. Additional elements focus on imaging of the brain, the cerebral vasculature, and the heart. These new elements may improve the care and outcomes for patients with stroke cared for at a Primary Stroke Center.
authors.affiliation: Northwestern University, 710 N Lake Shore Drive, 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: Andy
authors.initials: A
authors.lastname: Jagoda
authors.forename: Lawrence R
authors.initials: LR
authors.lastname: Wechsler
authors.forename: Todd
authors.initials: T
authors.lastname: Crocco
authors.forename: Mary G
authors.initials: MG
authors.lastname: George
authors.forename: E S
authors.initials: ES
authors.lastname: Connolly
authors.forename: Barbara
authors.initials: B
authors.lastname: Mancini
authors.forename: Stephen
authors.initials: S
authors.lastname: Prudhomme
authors.forename: Daryl
authors.initials: D
authors.lastname: Gress
authors.forename: Mary E
authors.initials: ME
authors.lastname: Jensen
authors.forename: Robert
authors.initials: R
authors.lastname: Bass
authors.forename: Robert
authors.initials: R
authors.lastname: Ruff
authors.forename: Kathy
authors.initials: K
authors.lastname: Foell
authors.forename: Rocco A
authors.initials: RA
authors.lastname: Armonda
authors.forename: Marian
authors.initials: M
authors.lastname: Emr
authors.forename: Margo
authors.initials: M
authors.lastname: Warren
authors.forename: Jim
authors.initials: J
authors.lastname: Baranski
authors.forename: Michael D
authors.initials: MD
authors.lastname: Walker
mesh_terms: D002533:Cerebral Angiography / Q000379:methods / Q000592:standards; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards*; D005260:Female; D006801:Humans; D016239:MEDLINE; D018810:Magnetic Resonance Angiography / Q000379:methods / Q000592:standards; D008297:Male; D012046:Rehabilitation / Q000379:methods / Q000458:organization & administration / Q000592:standards; D020521:Stroke / Q000000981:diagnostic imaging / Q000628:therapy*; D013686:Telemetry / Q000592:standards