Brain Attack Coalition Updates Recommendations for Primary Stroke Centers

September 1, 2011—The Brain Attack Coalition has issued revised and updated recommendations for the establishment of primary stroke centers to reflect the latest data and experience. Mark J. Alberts, MD, et al have published a summary statement of the recommendations in Stroke (2011;42:2651–2665). The Brain Attack Coalition noted that its original recommendations were made in 2000; since that time, the formation and certification of primary stroke centers has progressed rapidly.

As detailed in Stroke, the Brain Attack Coalition 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. The importance of some elements of the recommendations has been further strengthened, and several new areas have been added based on the literature review and experience at primary stroke centers.

Strengthened or additional elements include the importance of acute stroke teams; the importance of stroke units with telemetry monitoring; performance of brain imaging with magnetic resonance imaging and diffusion-weighted sequences; assessment of cerebral vasculature with magnetic resonance imaging angiography or computed tomographic angiography; cardiac imaging; early initiation of rehabilitation therapies; and certification by an independent body, including a site visit and disease performance measures. 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 stroke patients cared for at a primary stroke center, concluded the Brain Attack Coalition.