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Mark J. Alberts, MD; George Hademenos, PhD; Richard E. Latchaw, MD; Andrew Jagoda, MD; John R. Marler, MD; Marc R. Mayberg, MD; Rodman D. Starke, MD; Harold W. Todd; Kenneth M. Viste, MD; Meighan Girgus; Tim Shephard, RN; Marian Emr; Patti Shwayder, MPA; Michael D. Walker, MD; for the Brain Attack Coalition

JAMA. 2000;283:3102-3109.

Objective  To develop recommendations for the establishment and operation of primary stroke centers as an approach to improve the medical care of patients with stroke.

Participants  Members of the Brain Attack Coalition (BAC), a multidisciplinary group of representatives from major professional organizations involved with delivering stroke care. Supplemental input was obtained from other experts involved in acute stroke care.

Evidence  A review of literature published from 1966 to March 2000 was performed using MEDLINE. More than 600 English-language articles that had evidence from randomized clinical trials, meta-analyses, care guidelines, or other appropriate methods supporting specific care recommendations for patients with acute stroke that could be incorporated into a stroke center model were selected.

Consensus Process  Articles were reviewed initially by 1 author (M.J.A.). Members of the BAC reviewed each recommendation in the context of current practice parameters, with special attention to improving the delivery of care to patients with acute stroke, cost-effectiveness, and logistical issues related to the establishment of primary stroke centers. Consensus was reached among all BAC participants before an element was added to the list of recommendations.

Conclusions  Randomized clinical trials and observational studies suggest that several elements of a stroke center would improve patient care and outcomes. Key elements of primary stroke centers include acute stroke teams, stroke units, written care protocols, and an integrated emergency response system. Important support services include availability and interpretation of computed tomography scans 24 hours everyday and rapid laboratory testing. Administrative support, strong leadership, and continuing education are also important elements for stroke centers. Adoption of these recommendations may increase the use of appropriate diagnostic and therapeutic modalities and reduce peristroke complications. The establishment of primary stroke centers has the potential to improve the care of patients with stroke.

Author Affiliations: Division of Neurology, Duke University Medical Center, Durham, NC (Dr Alberts); American Heart Association, Dallas, Tex (Drs Hademenos and Starke and Ms Girgus); Department of Radiology, University of Miami School of Medicine, Miami, Fla (Dr Latchaw); Department of Emergency Medicine, Mount Sinai Medical Center, New York, NY (Dr Jagoda); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Rockville, Md (Drs Marler and Walker and Ms Emr); Department of Neurology, the Cleveland Clinic Foundation, Cleveland, Ohio (Dr Mayberg); National Stroke Association, Englewood, Colo (Mr Todd and Ms Shwayder); Lakeside Neurocare, Oshkosh, Wis (Dr Viste); and Medical College of Virginia Hospitals and Virginia Commonwealth University Neuroscience Center, Richmond (Mr Shephard).

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