This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (180)  • Contact me when this article is cited  Related Content  • Related letter  • Related articles  • Similar articles in JAMA  Topic Collections  • Neurology  • Cerebrovascular Disease  • Stroke  • Emergency Medicine  • Alert me on articles by topic  Social Bookmarking   What's this?

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).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

RELATED LETTER

Issues in Establishing Primary Stroke Centers
Richard D. Zorowitz, Scott R. Helmers, and Mark J. Alberts
JAMA. 2000;284(13):1647.
EXTRACT | FULL TEXT  

RELATED ARTICLES

The Imperative to Develop Dedicated Stroke Centers
H. J. M. Barnett and Alastair M. Buchan
JAMA. 2000;283(23):3125-3126.
EXTRACT | FULL TEXT  

June 21, 2000
JAMA. 2000;283(23):3135.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

National Institutes of Health Stroke Scale Certification Is Reliable Across Multiple Venues
Lyden et al.
Stroke 2009;40:2507-2511.
ABSTRACT | FULL TEXT  

Stroke networks based on robotic telepresence
Lai
J Telemed Telecare 2009;15:135-136.
ABSTRACT | FULL TEXT  

Resident-Based Acute Stroke Protocol Is Expeditious and Safe
Ford et al.
Stroke 2009;40:1512-1514.
ABSTRACT | FULL TEXT  

A mobile telemedicine system for remote consultation in cases of acute stroke
Kim et al.
J Telemed Telecare 2009;15:102-107.
ABSTRACT | FULL TEXT  

Intra-Arterial Stroke Therapy: An Assessment of Demand and Available Work Force
Cloft et al.
Am. J. Neuroradiol. 2009;30:453-458.
ABSTRACT | FULL TEXT  

Predicting Aspiration in Patients With Ischemic Stroke: Comparison of Clinical Signs and Aerodynamic Measures of Voluntary Cough
Smith Hammond et al.
Chest 2009;135:769-777.
ABSTRACT | FULL TEXT  

Get With the Guidelines-Stroke Is Associated With Sustained Improvement in Care for Patients Hospitalized With Acute Stroke or Transient Ischemic Attack
Schwamm et al.
Circulation 2009;119:107-115.
ABSTRACT | FULL TEXT  

Stroke Telemedicine
Demaerschalk et al.
Mayo Clin Proc. 2009;84:53-64.
ABSTRACT | FULL TEXT  

Atherosclerotic Peripheral Vascular Disease Symposium II: Stroke Intervention: State of the Art
Alberts et al.
Circulation 2008;118:2845-2851.
FULL TEXT  

Public Reporting of Quality Data for Stroke: Is It Measuring Quality?
Kelly et al.
Stroke 2008;39:3367-3371.
ABSTRACT | FULL TEXT  

Thrombolytic Therapy for Acute Stroke -- Not a Moment to Lose
Lyden
NEJM 2008;359:1393-1395.
FULL TEXT  

Factors That Influence the Stroke Care Team's Effectiveness in Reducing the Length of Hospital Stay
Schouten et al.
Stroke 2008;39:2515-2521.
ABSTRACT | FULL TEXT  

Access to State-of-the-Art Healthcare: a Missing Dynamic in Consumer Selection of a Retirement Community
Perrotta and Perrotta
JAOA: Journal of the American Osteopathic Association 2008;108:297-305.
ABSTRACT | FULL TEXT  

Potential for quality improvement of acute stroke management in a district general hospital
McCarron et al.
Emerg. Med. J. 2008;25:270-273.
ABSTRACT | FULL TEXT  

The time is right to improve organization of stroke care
Suarez and Kent
Neurology 2008;70:1232-1233.
FULL TEXT  

Development of a Metropolitan Matrix of Primary Stroke Centers: The Phoenix Experience
Demaerschalk et al.
Stroke 2008;39:1246-1253.
ABSTRACT | FULL TEXT  

Implementation Strategies for Emergency Medical Services Within Stroke Systems of Care: A Policy Statement From the American Heart Association/ American Stroke Association Expert Panel on Emergency Medical Services Systems and the Stroke Council
Acker et al.
Stroke 2007;38:3097-3115.
FULL TEXT  

Acute Ischemic Stroke Treatment in 2007
Goldstein
Circulation 2007;116:1504-1514.
FULL TEXT  

Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists.
Adams et al.
Circulation 2007;115:e478-e534.
ABSTRACT | FULL TEXT  

Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/ American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists
Adams et al.
Stroke 2007;38:1655-1711.
ABSTRACT | FULL TEXT  

Slow Progressive Acceptance of Intravenous Thrombolysis for Patients With Stroke by Rural Primary Care Physicians
Leira et al.
Arch Neurol 2007;64:518-521.
ABSTRACT | FULL TEXT  

Stroke care delivery before vs after JCAHO stroke center certification
Stradling et al.
Neurology 2007;68:469-470.
FULL TEXT  

Development and Implementation of Evidence-Based Indicators for Measuring Quality of Acute Stroke Care: The Quality Indicator Board of the German Stroke Registers Study Group (ADSR)
Heuschmann et al.
Stroke 2006;37:2573-2551.
ABSTRACT | FULL TEXT  

Early stroke care in Italy--a steep way ahead: an observational study.
Citerio et al.
Emerg. Med. J. 2006;23:608-611.
ABSTRACT | FULL TEXT  

Quality improvement in acute stroke: The New York State Stroke Center Designation Project.
Gropen et al.
Neurology 2006;67:88-93.
ABSTRACT | FULL TEXT  

Reducing Delay in Seeking Treatment by Patients With Acute Coronary Syndrome and Stroke: A Scientific Statement From the American Heart Association Council on Cardiovascular Nursing and Stroke Council
Moser et al.
Circulation 2006;114:168-182.
ABSTRACT | FULL TEXT  

Thrombolysis (Tissue Plasminogen Activator) in Stroke: A Medicolegal Quagmire
Weintraub
Stroke 2006;37:1917-1922.
ABSTRACT | FULL TEXT  

Case records of the Massachusetts General Hospital. Case 16-2006. A 72-year-old woman admitted to the emergency department because of a sudden change in mental status.
Thomas et al.
NEJM 2006;354:2263-2271.
FULL TEXT  

Improving the Clinical Diagnosis of Stroke
Goldstein
Stroke 2006;37:754-755.
FULL TEXT  

Prospective reliability of the STRokE DOC Wireless/Site Independent Telemedicine System
Gross et al.
Neurology 2006;66:460-460.
FULL TEXT  

Organized Stroke Care
Norrving and Adams
Stroke 2006;37:326-328.
FULL TEXT  

Economic Benefit of Increasing Utilization of Intravenous Tissue Plasminogen Activator for Acute Ischemic Stroke in the United States
Demaerschalk and Yip
Stroke 2005;36:2500-2503.
ABSTRACT | FULL TEXT  

Recommendations for Comprehensive Stroke Centers: A Consensus Statement From the Brain Attack Coalition
Alberts et al.
Stroke 2005;36:1597-1616.
ABSTRACT | FULL TEXT  

Editorial Comment--Organized Stroke Care: The Core of Effective Stroke Care Provision
Norrving
Stroke 2005;36:1616-1618.
FULL TEXT  

Houston Paramedic and Emergency Stroke Treatment and Outcomes Study (HoPSTO)
Wojner-Alexandrov et al.
Stroke 2005;36:1512-1518.
ABSTRACT | FULL TEXT  

Improved Quality of Stroke Care for Hospitalized Medicare Beneficiaries in Michigan
Jacobs et al.
Stroke 2005;36:1227-1231.
ABSTRACT | FULL TEXT  

Prospective reliability of the STRokE DOC Wireless/Site Independent Telemedicine System
Meyer et al.
Neurology 2005;64:1058-1060.
ABSTRACT | FULL TEXT  

Recommendations for the Establishment of Stroke Systems of Care: Recommendations From the American Stroke Association's Task Force on the Development of Stroke Systems
Task Force Members et al.
Stroke 2005;36:690-703.
FULL TEXT  

Recommendations for the Establishment of Stroke Systems of Care: Recommendations From the American Stroke Association's Task Force on the Development of Stroke Systems
Schwamm et al.
Circulation 2005;111:1078-1091.
FULL TEXT  

Lower stroke-related mortality in counties with stroke centers: North Carolina Stroke Facilities Survey
Camilo and Goldstein
Neurology 2005;64:762-763.
FULL TEXT  

February 8 Highlight and Commentary: Criteria for stroke centers
Neurology 2005;64:403-403.
FULL TEXT  

Do the Brain Attack Coalition's criteria for stroke centers improve care for ischemic stroke?
Douglas et al.
Neurology 2005;64:422-427.
ABSTRACT | FULL TEXT  

Telemedicine for Safe and Extended Use of Thrombolysis in Stroke: The Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria
Audebert et al.
Stroke 2005;36:287-291.
ABSTRACT | FULL TEXT  

Training, competency, and credentialing standards for diagnostic cervicocerebral angiography, carotid stenting, and cerebrovascular intervention: A Joint Statement from the American Academy of Neurology, the American Association of Neurological Surgeons, the American Society of Interventional and Therapeutic Neuroradiology, the American Society of Neuroradiology, the Congress of Neurological Surgeons, the AANS/CNS Cerebrovascular Section, and the Society of Interventional Radiology
Connors et al.
Neurology 2005;64:190-198.
FULL TEXT  

Training, Competency, and Credentialing Standards for Diagnostic Cervicocerebral Angiography, Carotid Stenting, and Cerebrovascular Intervention: A Joint Statement from the American Academy of Neurology, American Association of Neurological Surgeons, American Society of Interventional and Therapeutic Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, AANS/CNS Cerebrovascular Section, and Society of Interventional Radiology
Connors et al.
Radiology 2005;234:26-34.
FULL TEXT  

Predictors of In-Hospital Mortality and Attributable Risks of Death After Ischemic Stroke: The German Stroke Registers Study Group
Heuschmann et al.
Arch Intern Med 2004;164:1761-1768.
ABSTRACT | FULL TEXT  

Stroke Care Delivery in Institutions Participating in the Registry of the Canadian Stroke Network
Kapral et al.
Stroke 2004;35:1756-1762.
ABSTRACT | FULL TEXT  

Racial and Ethnic Disparities in Cardiovascular Risk Factors Among Stroke Survivors: United States 1999 to 2001
McGruder et al.
Stroke 2004;35:1557-1561.
ABSTRACT | FULL TEXT  

Regionalization of Treatment for Subarachnoid Hemorrhage: A Cost-Utility Analysis
Bardach et al.
Circulation 2004;109:2207-2212.
ABSTRACT | FULL TEXT  

Editorial Comment--More Than One Way to Lyse a Clot
Kasner
Stroke 2004;35:911-912.
FULL TEXT  

A population-based study of acute stroke and TIA diagnosis
Morgenstern et al.
Neurology 2004;62:895-900.
ABSTRACT | FULL TEXT  

Case 5-2004 - A 57-Year-Old Man with Slurred Speech and Left Hemiparesis
Carter et al.
NEJM 2004;350:707-716.
FULL TEXT  

Acute Ischemic Stroke in Hospitalized Medicare Patients: Evaluation and Treatment
Roychoudhury et al.
Stroke 2004;35 :e22-e23.
ABSTRACT | FULL TEXT  

Statewide Assessment of Hospital-Based Stroke Prevention and Treatment Services in North Carolina: Changes Over the Last 5 Years
Camilo and Goldstein
Stroke 2003;34:2945-2950.
ABSTRACT | FULL TEXT  

Brains, claims, and the pharmaceutical industry
Alberts et al.
BMJ 2003;327:E107-109.
FULL TEXT  

Paramedic and Emergency Department Care of Stroke: Baseline Data From a Citywide Performance Improvement Study
Wojner et al.
Am J Crit Care 2003;12:411-417.
ABSTRACT | FULL TEXT  

Impact of Establishing a Primary Stroke Center at a Community Hospital on the Use of Thrombolytic Therapy: The NINDS Suburban Hospital Stroke Center Experience
Lattimore et al.
Stroke 2003;34 :e55-e57.
ABSTRACT | FULL TEXT  

Establishment of primary stroke centers: A survey of physician attitudes and hospital resources
Kidwell et al.
Neurology 2003;60:1452-1456.
ABSTRACT | FULL TEXT  

Cuyahoga County Operation Stroke Speed of Emergency Department Evaluation and Compliance With National Institutes of Neurological Disorders and Stroke Time Targets
Katzan et al.
Stroke 2003;34:994-998.
ABSTRACT | FULL TEXT  

Hospital-Based Study of the Care and Cost of Acute Ischemic Stroke in Japan
Yoneda et al.
Stroke 2003;34:718-724.
ABSTRACT | FULL TEXT  

Telemedicine for Acute Stroke: Triumphs and Pitfalls
LaMonte et al.
Stroke 2003;34:725-728.
ABSTRACT | FULL TEXT  

Use of a Field-to-Stroke Center Helicopter Transport Program to Extend Thrombolytic Therapy to Rural Residents
Silliman et al.
Stroke 2003;34:729-733.
ABSTRACT | FULL TEXT  

Establishing Data Elements for the Paul Coverdell National Acute Stroke Registry: Part 1: Proceedings of an Expert Panel
Wattigney et al.
Stroke 2003;34:151-156.
ABSTRACT | FULL TEXT  

Thrombolysis for Acute Stroke in Routine Clinical Practice
Bravata et al.
Arch Intern Med 2002;162:1994-2001.
ABSTRACT | FULL TEXT  

Description and evaluation of an acute stroke unit
Phillips et al.
CMAJ 2002;167:655-660.
ABSTRACT | FULL TEXT  

A multicentre observational study of presentation and early assessment of acute stroke
Harraf et al.
BMJ 2002;325:17-17.
ABSTRACT | FULL TEXT  

Acute Stroke Care in Illinois: A Statewide Assessment of Diagnostic and Treatment Capabilities * Editorial Comment: A Statewide Assessment of Diagnostic and Treatment Capabilities
Ruland et al.
Stroke 2002;33:1334-1340.
ABSTRACT | FULL TEXT  

Alteplase for stroke: money and optimistic claims buttress the "brain attack" campaign * Commentary: Who pays the guideline writers? * Commentary: Thrombolysis in stroke: it works!
Lenzer et al.
BMJ 2002;324:723-729.
FULL TEXT  

Recommendations for Improving the Quality of Care Through Stroke Centers and Systems: An Examination of Stroke Center Identification Options: Multidisciplinary Consensus Recommendations from the Advisory Working Group on Stroke Center Identification Options of the American Stroke Association
Adams et al.
Stroke 2002;33 :e1-e7.
FULL TEXT  

Acute stroke care in non-urban emergency departments
Burgin et al.
Neurology 2001;57:2006-2012.
ABSTRACT | FULL TEXT  

Intravenous Tissue-Type Plasminogen Activator Therapy for Ischemic Stroke: Houston Experience 1996 to 2000
Grotta et al.
Arch Neurol 2001;58:2009-2013.
ABSTRACT | FULL TEXT  

Development of Performance Measures for Acute Ischemic Stroke Editorial Comment
Holloway et al.
Stroke 2001;32:2058-2074.
ABSTRACT | FULL TEXT  

Characteristics of Academic Medical Centers and Ischemic Stroke Outcomes
Gillum and Johnston
Stroke 2001;32:2137-2142.
ABSTRACT | FULL TEXT  

Physician Knowledge of the Benefits, Risks, and Contraindications of Tissue Plasminogen Activator for Acute Ischemic Stroke
Merino et al.
Stroke 2001;32 :2208-2209.
FULL TEXT  

Update on intravenous tissue plasminogen activator for acute stroke: from clinical trials to clinical practice
Gladstone and Black
CMAJ 2001;165:311-317.
ABSTRACT | FULL TEXT  

Community Use of Intravenous Tissue Plasminogen Activator for Acute Stroke : Results of the Brain Matters Stroke Management Survey Editorial Comment: Results of the Brain Matters Stroke Management Survey
Katzan et al.
Stroke 2001;32:861-865.
ABSTRACT | FULL TEXT  

Guidelines for Stroke Center Development
Zubair Kareem
Stroke 2001;32:816-818.
FULL TEXT  

Additional articles abstracted in ACP Journal Club
Evid. Based Med. 2001;6:3-3.
FULL TEXT  

Determinants of Use of Emergency Medical Services in a Population With Stroke Symptoms : The Second Delay in Accessing Stroke Healthcare (DASH II) Study
Schroeder et al.
Stroke 2000;31:2591-2596.
ABSTRACT | FULL TEXT  

Issues in Establishing Primary Stroke Centers
Zorowitz et al.
JAMA 2000;284:1647-1647.
FULL TEXT  

The Center Concept in Management of Acute Stroke
JWatch Neurology 2000;2000:3-3.
FULL TEXT  

The Imperative to Develop Dedicated Stroke Centers
Barnett and Buchan
JAMA 2000;283:3125-3126.
FULL TEXT