Formation and Function of Acute Stroke–Ready Hospitals Within a Stroke System of Care Recommendations From the Brain Attack Coalition

Abstract

Background and Purpose— Many patients with an acute stroke live in areas without ready access to a Primary or Comprehensive Stroke Center. The formation of care facilities that meet the needs of these patients might improve their care and outcomes and guide them and emergency responders to such centers within a stroke system of care. Methods— The Brain Attack Coalition conducted an electronic search of the English medical literature from January 2000 to December 2012 to identify care elements and processes shown to be beneficial for acute stroke care. We used evidence grading and consensus paradigms to synthesize recommendations for Acute Stroke–Ready Hospitals (ASRHs). Results— Several key elements for an ASRH were identified, including acute stroke teams, written care protocols, involvement of emergency medical services and emergency department, and rapid laboratory and neuroimaging testing. Unique aspects include the use of telemedicine, hospital transfer protocols, and drip and ship therapies. Emergent therapies include the use of intravenous tissue-type plasminogen activator and the reversal of coagulopathies. Although many of the care elements are similar to those of a Primary Stroke Center, compliance rates of ≥67% are suggested in recognition of the staffing, logistical, and financial challenges faced by rural facilities. Conclusions— ASRHs will form the foundation for acute stroke care in many settings. Recommended elements of an ASRH build on those proven to improve care and outcomes at Primary Stroke Centers. The ASRH will be a key component for patient care within an evolving stroke system of care.

Drip and Ship Thrombolytic Therapy for Acute Ischemic Stroke

“…Были опубликованы националь-ные данные, но в них не было клинических деталей [11]. Генерализуемость данных о безопасности, в частности необходимо подтвердить у пациентов для повседнев-ной клинической практики, поскольку метод «drip and ship» используют достаточно часто [12]. Для удовлет-ворения потребности в проведении современного ана-лиза большого набора данных из клинической практи-ки, был проанализирован национальный реестр США Get With The Guidelines (GWTG)-Stroke с целью опреде-ления: (1) частоты и временных тенденций использова-ния стратегии «drip and ship»; (2) различий в соблюдении рекомендаций по ведению пациентов после системного тромболизиса; (3) ассоциации между использованием метода «drip and ship» и исходами у пациентов с острым ИИ после внутривенного введения ТАП.…”

“…11 The generalizability of safety data, in particular, must be confirmed in patients treated in routine clinical practice because the drip and ship method becomes more commonly adopted. 12 To address the need for a contemporary analysis of a large, clinical practice-derived data set, the US national Get With The Guidelines (GWTG)-Stroke registry was analyzed to determine (1) the frequency and temporal trends in the use of the drip and ship strategy, (2) differences in guideline-based care post-IV tPA, and (3) the association of the drip and ship method of tPA administration with outcomes in patients with acute ischemic stroke.…”

Acute Stroke Through the Perspective of a County Hospital: Problems and Opportunities

“…Bu sorunlar ve çözüm önerileri literatürdeki veriler ışığında, ülkemizdeki özel koşullar da eklenerek Tablo 2'de özetlenmiştir (25,26,27,28). Gerekli düzenlemeler yapıldığı takdirde inme hastalarına bakım daha iyi bir seviyeye çıkarılabilecektir.…”

Effectiveness of regionalized systems for stroke and myocardial infarction

“…1994, 1996, 2003, 2005, 2007; The National Institute of Neurological Disorders and Stroke rt‐PA Stoke Study Group, 1995; Levine and Gorman 1999; Alberts et al. 2000, 2005, 2011, 2013; Albers et al. 2004; Schwamm et al.…”