Revised and Updated Recommendations for the Establishment of Primary Stroke Centers

Abstract

for the Brain Attack CoalitionBackground and Purpose-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. (Stroke. 2011;42:2651-2665.)

Accuracy of ICD‐9‐CM Codes by Hospital Characteristics and Stroke Severity: Paul Coverdell National Acute Stroke Program

“…We noted higher agreement between the clinical diagnosis and primary discharge code in hospitals with dedicated stroke units and teams. This supports the Brain Attack Coalition's premise that stroke units and teams are associated with better patient care processes,27 in part attributed to the availability of subspecialists, and imaging resources that improve the diagnostic classification of conditions based on current guidelines 28. The observed disagreement between TIAs and minor strokes in our study warrants further investigation in future studies, given the forthcoming inclusion of the NIHSS to assess severity in ICD‐10‐CM codes.…”

A pediatric institutional acute stroke protocol improves timely access to stroke treatment

“…2,15 In adult stroke centers, comprehensive stroke protocols increase access to stroke treatment, decreasing costs, and improving outcomes. 2,[16][17][18][19] Referral of children with acute stroke to centers with pediatric stroke teams is now recommended. 8 Such centers employ acute stroke protocols (ASPs), a relatively new phenomenon.…”

Racial Disparities in Intravenous Recombinant Tissue Plasminogen Activator Use Persist at Primary Stroke Centers

“…The past decade has witnessed broad adoption of stroke systems of care with EMS routing protocols focused on early detection of acute ischemic stroke, and prompt transport of patients to stroke centers 13, 14, 15. In December 2003, The Joint Commission established a national certification process for Primary Stroke Centers (PSCs), based on recommendations from the Brain Attack Coalition.…”

“…In December 2003, The Joint Commission established a national certification process for Primary Stroke Centers (PSCs), based on recommendations from the Brain Attack Coalition. Hospitals seeking certification were required to implement elements such as an acute stroke team, written care protocols, coordination with EMS, and creation of a stroke unit 13. Growing evidence indicates that PSCs utilize more rt‐PA than non‐PSCs and have lower mortality rates than noncertified hospitals 16, 17, 18, 19, 20…”