Stroke: Care guidelines for primary stroke centers updated

Primary stroke centers improve care and are an important component in the care continuum of stroke patients. In the September issue of Stroke, members of the Brain Attack Coalition updated recommendations for the formation and operation of primary stroke centers (PSC) with the goal of enhancing diagnoses and improving care.

For the report, coalition members used MEDLINE and PubMed data from March 2000 to January 2011 to conduct a literature review to outline the most relevant strategies for acute stroke diagnosis, treatment and care. Currently, nearly 800 primary stroke centers are certified by the Joint Commission.

Because there have been a number modifications and changes in stroke care, Mark J. Alberts, MD, on behalf of the Brain Attack Coalition, and colleagues updated the current guidelines to include endovascular therapies and advantageous strategies of stroke care.

These modifications center on:

• Acute stroke team (AST): These teams should involve at least one physician and one other healthcare provider (i.e., a nurse, physician’s assistant or nurse practitioner) who will be available two hours every day, seven days a week. Evidence-based protocols should be used by all AST members to guide acute stroke care.
• Stroke units with telemetry monitoring: Incorporating stroke units can decrease mortality. Telemetry should be capable of monitoring blood pressure, pulse, respiration and oxygenation.
• Brain imaging with MRI and diffusion-weighted sequences: The ability to perform brain and vascular imaging studies on patients with acute stroke is vital for determining an accurate and timely diagnosis. These provide information about vascular abnormalities and mechanisms about the cause of stroke that could help with diagnosis.
• Assessing cerebral vasculature with MR angiography or CT angiography: Although an MRI may not be needed for every patient with stroke, it should be available at a PSC for those patients who are admitted and might benefit from such testing.
• Cardiac imaging: Cardiac imaging using transthoracic echocardiography (TTE), transesophageal echocardiography (TEE) or cardiac MRI often provides important information about underlying cardiac and aortic pathologies that may determine an etiology for a stroke and offers important information about further therapies. The coalition recommends that a primary stroke center have at least one modality (TTE or TEE) to image the heart for all patients admitted with stroke.
• Early initiation of rehabilitation therapies: Speech therapy, physical therapy and occupational therapy improve post-stroke recovery and overall function. The coalition noted that a rehabilitation assessment should be conducted and these forms of therapy should be part of the primary stroke center.
• Certification by an independent body: This would include a site visit and disease performance measures.

“We anticipate the updated disease performance measures that mirror these recommendations will result in improved care for patients at a primary stroke center,” the authors wrote. “It is anticipated that if hospitals adopt and follow these recommendations, patients will achieve more accurate diagnoses, more timely therapies and improved overall outcomes.”

Incorporating the aforementioned elements into stroke care will improve the outcomes of acute stroke patients treated at primary stroke centers, the authors concluded.

The coalition released its first recommendations for primary stroke centers in 2000.