Skip to main content

Advertisement

SpringerLink
Log in

Organization of regional and local stroke resources: Methods to expedite acute management of stroke

  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

Proving the efficacy of thrombolysis in improving outcome from stroke has put time to assessment of patients at the forefront for healthcare providers when organizing stroke care. The chain of recovery begins with the patient. Efforts are being made to improve the general public’s understanding of stroke. However, it appears at the moment that a greater effect in reducing the delay to initial medical assessment and treatment decision is to be gained through streamlining care as soon as 911 has been called. Emergency medical services dispatchers and technicians play a key role in recognizing that a patient is having a stroke and prioritizing the transport of the patient to an appropriate facility. Emergency departments need to have clear protocols in place to ensure that physicians can make prompt treatment decisions after having fully assessed and investigated the patient. Only with all these pieces in place is the initial phase of the chain of recovery complete, with the end result that more patients have the chance to have an improved outcome from stroke.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. The National Institute of Neurological Disorders and Stroke rtPA Stroke Study Group: Tissue plasminogen activator for acute ischaemic stroke. N Engl J Med 1995, 333:1581–1587.

    Article  Google Scholar 

  2. Furlan A, Higashida R, Wechsler L, et al., for the PROACT Investigators: Intra-arterial Prourokinase for Acute Ischemic Stroke. JAMA 1999, 282:2003–2011.

    Article  PubMed  CAS  Google Scholar 

  3. Marler JR, Tilley BC, Lu M, et al.: Early stroke treatment associated with better outcome: the NINDS rt-PA stroke study. Neurology 2000, 55:1649–1655. This paper is the key piece of evidence in altering healthcare delivery so that patients are seen as soon as possible to maximize the chances of an excellent neurologic recovery from stroke.

    PubMed  CAS  Google Scholar 

  4. Wardlaw JM, del Zoppo G, Yamaguchi T: Thrombolysis for acute ischemic stroke (Cochrane Review on CD-ROM). Oxford, England: Cochrane Library, Update Software; 2002.

    Google Scholar 

  5. National Institute of Neurological Disorders and Stroke rtPA Stroke Study Group: Intracerebral hemorrhage after intravenous t-PA therapy for ischemic stroke. Stroke 1997, 28:2109–2118.

    Google Scholar 

  6. Buchan AM, Barber PA, Newcommon N, et al.: Effectiveness of t-PA in acute ischemic stroke: outcome relates to appropriateness. Neurology 2000, 54:679–684.

    PubMed  CAS  Google Scholar 

  7. Katzan IL, Furlan AJ, Lloyd LE, et al.: Use of tissue plasminogen activator for acute ischemic stroke: the Cleveland area experience. JAMA 2000, 283:1151–1158.

    Article  PubMed  CAS  Google Scholar 

  8. Horrowitz SH: Thrombolytic therapy in acute stroke. Arch Neurol 1998, 55:155–157.

    Article  Google Scholar 

  9. Kennedy J, Buchan AM, Barnett HJ: Thrombolysis must be considered after stroke [letter]. BMJ 2001, 323:937.

    Article  PubMed  CAS  Google Scholar 

  10. Fieschi C, Argentino C, Lenzi GL, et al.: Therapeutic window for pharmacological treatment in acute focal cerebral ischemia. Ann N Y Acad Sci 1988, 522:662–666.

    Article  PubMed  CAS  Google Scholar 

  11. Ringelstein FB, Biniek R, Weiller C, et al.: Type and extent of hemispheric infarctions and clinical outcomes in early and delayed middle cerebral artery recanalization. Neurology 1992, 42:289–298.

    PubMed  CAS  Google Scholar 

  12. Siesjo BK: Pathophysiology and treatment of focal cerebral ischaemia, I: pathophysiology. J Neurosurg 1992, 77:169–184.

    PubMed  CAS  Google Scholar 

  13. Pepe PE, Zachariah BS, Sayre MR, et al.: Ensuring the chain of recovery for stroke in your community. Acad Emerg Med 1998, 5:352–358.

    Article  PubMed  CAS  Google Scholar 

  14. Pancioli AM, Broderick J, Kothari R, et al.: Public perception of stroke warning signs and knowledge of potential risk factors. JAMA 1998, 279:1288–1292.

    Article  PubMed  CAS  Google Scholar 

  15. Kothari R, Sauerbeck L, Jauch E, et al.: Patients’ awareness of stroke signs, symptoms, and risk factors. Stroke 1997, 28:1871–1875.

    PubMed  CAS  Google Scholar 

  16. Brott TG, Haley EC Jr, Levy DE, et al.: Urgent therapy for stroke, I: pilot study of tissue plasminogen activator administered within 90 minutes. Stroke 1992, 23:632–640.

    PubMed  CAS  Google Scholar 

  17. Haley EC Jr, Levy DE, Brott TG, et al.: Urgent therapy for stroke, II: pilot study of tissue plasminogen activator administered 91–180 minutes from onset. Stroke 1992, 23:641–645.

    PubMed  Google Scholar 

  18. Silver FL, Rubini F, Black D, Hodgson CS: Advertising strategies to increase public knowledge of the warning signs of stroke. Stroke 2003, 34:1965–1968. In the presence of scarce resources, this paper shows that television, as opposed to newsprint media, is the most effective way to increase the general public’s understanding of stroke.

    Article  PubMed  Google Scholar 

  19. Williams LS, Bruno A, Rouch D, Marriott MA: Stroke patients’ knowledge of stroke. Stroke 1997, 28:912–915.

    PubMed  CAS  Google Scholar 

  20. Alberts MJ, Perry A, Dawson DV, Bertels C: Effects of public and professional education on reducing the delay in presentation and referral of stroke patients. Stroke 1992, 23:352–356.

    PubMed  CAS  Google Scholar 

  21. Kereiakes DJ, Weaver WD, Anderson JL, et al.: Time delays in the diagnosis and treatment of acute myocardial infarction: a tale of eight cities. Report from the Pre-hospital Study Group and the Cincinnati Heart Project. Am Heart J 1990, 120:773–780.

    Article  PubMed  CAS  Google Scholar 

  22. Goff DC, Nichaman MZ, Ramsey DJ, et al.: A population-based assessment of the use and effectiveness of thrombolytic therapy: the Corpus Christi Heart Project. Ann Epidemiol 1995, 5:171–178.

    Article  PubMed  Google Scholar 

  23. Luepker RV, Raczynski JM, Osganian S, et al.: Effect of a community intervention on patient delay and emergency medical service use in acute coronary heart disease: The Rapid Early Action for Coronary Treatment (REACT) Trial. JAMA 2000, 284:60–67. Highlights the problems of transferring public education into reduced treatment times.

    Article  PubMed  CAS  Google Scholar 

  24. Raczynski JM, Finnegan JR Jr, Zapka JG, et al.: REACT theorybased intervention to reduce treatment-seeking delay for acute myocardial infarction. Rapid Early Action for Coronary Treatment. Am J Prev Med 1999, 16:325–334.

    Article  PubMed  CAS  Google Scholar 

  25. Harper GD, Haigh RA, Potter JF, Castleden CM: Factors delaying hospital admission after stroke in Leicestershire. Stroke 1992, 23:835–838.

    PubMed  CAS  Google Scholar 

  26. Feldmann E, Gordon N, Brooks JM, et al.: Factors associated with early presentation of acute stroke. Stroke 1993, 24:1805–1810.

    PubMed  CAS  Google Scholar 

  27. Fogelholm R, Murros K, Rissanen A, Ilmavirta M: Factors delaying hospital admission after acute stroke. Stroke 1996, 27:398–400.

    PubMed  CAS  Google Scholar 

  28. Barsan WG, Brott TG, Broderick JP, et al.: Time of hospital presentation in patients with acute stroke. Arch Intern Med 1993, 153:2558–2561.

    Article  PubMed  CAS  Google Scholar 

  29. Wester P, Radberg J, Lundgren B, Peltonen M: Factors associated with delayed admission to hospital and inhospital delays in acute stroke and TIA: a prospective, multicenter study. Seek-Medical-Attention-in-Time Study Group. Stroke 1999, 30:40–48.

    PubMed  CAS  Google Scholar 

  30. Kothari R, Jauch E, Broderick J, et al.: Acute stroke: delays to presentation and emergency department evaluation. Ann Emerg Med 1999, 33:3–8.

    Article  PubMed  CAS  Google Scholar 

  31. Lacy CR, Suh DC, Bueno M, Kostis JB: Delay in presentation and evaluation for acute stroke: Stroke Time Registry for Outcomes Knowledge and Epidemiology (S.T.R.O.K.E.). Stroke 2001, 32:63–69.

    PubMed  CAS  Google Scholar 

  32. Schroeder EB, Rosamond WD, Morris DL, et al.: Determinants of use of emergency medical services in a population with stroke symptoms: the Second Delay in Accessing Stroke Healthcare (DASH II) Study. Stroke 2000, 31:2591–2596.

    PubMed  CAS  Google Scholar 

  33. Goldstein LB, Edwards MG, Wood DP: Delay between stroke onset and emergency department evaluation. Neuroepidemiology 2001, 20:196–200.

    Article  PubMed  CAS  Google Scholar 

  34. Menon SC, Pandey DK, Morgenstern LB: Critical factors determining access to acute stroke care. Neurology 1998, 51:427–432.

    PubMed  CAS  Google Scholar 

  35. Harraf F, Sharma AK, Brown MM, et al.: A multicentre observational study of presentation and early assessment of acute stroke. BMJ 2002, 325:17–21.

    Article  PubMed  Google Scholar 

  36. Barsan WG, Brott TG, Broderick JP, et al.: Urgent therapy for acute stroke. Effects of a stroke trial on untreated patients. Stroke 1994, 25:2132–2137.

    PubMed  CAS  Google Scholar 

  37. Evenson KR, Rosamond WD, Morris DL: Prehospital and inhospital delays in acute stroke care. Neuroepidemiology 2001, 20:65–76.

    Article  PubMed  CAS  Google Scholar 

  38. Evensen KR, Schroeder EB, Legare TB, et al.: A comparison of emergency medical services times for stroke and myocardial infarction. Prehosp Emerg Care 2001, 5:335–339.

    Google Scholar 

  39. Porteus GH, Corry MD, Smith WS: Emergency medical services dispatcher identification of stroke and transient ischemic attack. Prehosp Emerg Care 1999, 3:211–216.

    Google Scholar 

  40. Kothari RU, Pancioli A, Liu T, et al.: Cincinnati Prehospital Stroke Scale: reproducibility and validity. Ann Emerg Med 1999, 33:373–378.

    Article  PubMed  CAS  Google Scholar 

  41. Brott T, Adams HP, Olinger CP: Measurements of acute cerebral infarction: a clinical examination scale. Stroke 1989, 20:864–870.

    PubMed  CAS  Google Scholar 

  42. Harbison J, Hossain O, Jenkinson D, et al.: Diagnostic accuracy of stroke referrals from primary care, emergency room physicians and ambulance staff using the Face Arm Speech Test. Stroke 2003, 34:71–76.

    Article  PubMed  Google Scholar 

  43. Kidwell CS, Starkman S, Eckstein M, et al.: Identifying stroke in the field. Prospective validation of the Los Angeles prehospital stroke screen (LAPSS). Stroke 2000, 31:71–76.

    PubMed  CAS  Google Scholar 

  44. Scott PA, Temovsky CJ, Lawrence K, et al.: Analysis of Canadian population with potential geographic access to intravenous thrombolysis for acute ischemic stroke. Stroke 1998, 29:2304–2310.

    PubMed  CAS  Google Scholar 

  45. Chalela JA, Kasner SE, Jauch EC, Pancioli AM: Safety of air medical transportation after tissue plasminogen activator administration in acute ischemic stroke. Stroke 1999, 30:2366–2368.

    PubMed  CAS  Google Scholar 

  46. Levine SR, Gorman M: "Telestroke": the application of telemedicine for stroke. Stroke 1999, 30:464–469.

    PubMed  CAS  Google Scholar 

  47. Riopelle RJ, Howse DC, Bolton C, et al.: Regional access to acute ischemic stroke intervention. Stroke 2001, 32:652–655. Highlights the need for close cooperation between all healthcare providers to increase the access to care across a large geographical area, with end results that the rate of treatment with tPA increased.

    PubMed  CAS  Google Scholar 

  48. Alberts MJ, Hademenos G, Latchaw RE, et al.: for the Brain Attack Coalition: Recommendations for the establishment of primary stroke centers. JAMA 2000, 283:3102–3109.

    Article  PubMed  CAS  Google Scholar 

  49. National Institute of Neurological Disorders and Stroke: Proceedings of a National Symposium on Rapid Identification and Treatment of Acute Stroke. Washington, DC, 1997.

  50. Lin CS, Tsai J, Woo P, Chang H: Prehospital delay and emergency department management of ischemic stroke patients in Taiwan, ROC. Prehosp Emerg Care 1999, 3:194–200.

    PubMed  CAS  Google Scholar 

  51. Kothari R, Barsan W, Brott T, et al.: Frequency and accuracy of prehospital diagnosis of acute stroke. Stroke 1995, 26:937–941.

    PubMed  CAS  Google Scholar 

  52. Katzan IL, Graber TM, Furlan AJ, et al., for Cuyahoga County Operation Stroke: Cuyahoga County Operation Stroke speed of emergency department evaluation and compliance with National Institutes of Neurological Disorders and Stroke time targets. Stroke 2003, 34:994–998.

    Article  PubMed  Google Scholar 

  53. Goldstein LB, Hey LA, Laney R: North Carolina stroke prevention and treatment facilities survey. TPA therapy for acute stroke. Stroke 1998, 29:2069–2072.

    PubMed  CAS  Google Scholar 

  54. Ruland S, Gorelick PB, Schneck M, et al.: Acute stroke in Illinois: a statewide assessment of diagnostic and treatment capabilities. Stroke 2002, 33:1334–1340.

    Article  PubMed  Google Scholar 

  55. Tilley BC, Lyden PD, Brott TG, et al., for the NINDS Stroke Study Group: Total quality improvement method for reduction of delays between emergency department admission and treatment of acute ischemic stroke. Arch Neurol 1997, 54:1466–1474.

    PubMed  CAS  Google Scholar 

  56. Grotta JC, Burgin WS, El-Mitwalli A, et al.: Intravenous tissuetype plasminogen activator for ischemic stroke. Arch Neurol 2001, 58:2009–2013.

    Article  PubMed  CAS  Google Scholar 

  57. Kennedy J, Newcommon NJ, Cole-Haskayne A, et al.: Organised stroke care increases the number and the speed with which patients with acute ischemic stroke are thrombolysed. Stroke 2002, 33:354.

    Google Scholar 

  58. Chapman KM, Woolfenden AR, Graeb D, et al.: Intravenous tissue plasminogen activator for acute ischemic stroke. Stroke 2000, 31:2920–2924.

    PubMed  CAS  Google Scholar 

  59. Koennecke HC, Nohr R, Leistner S, Marx P: Intravenous tPA for ischemic stroke team performance over time, safety, and efficacy in a single-center, 2-year experience. Stroke 2001, 32:1074–1078.

    PubMed  CAS  Google Scholar 

  60. Grond M, Stenzel C, Schmulling S, et al.: Early intravenous thrombolysis for acute ischemic stroke in a communitybased approach. Stroke 1998, 29:1544–1549.

    PubMed  CAS  Google Scholar 

  61. Albers GW, Bates VE, Clark WM, et al.: Intravenous tissue-type plasminogen activator for treatment of acute stroke. JAMA 2000, 283:1145–1150.

    Article  PubMed  CAS  Google Scholar 

  62. Wang DZ, Rose JA, Honings DS, et al.: for the OSF Stroke Team: treating acute stroke patients with intravenous tPA. Stroke 2000, 31:77–81.

    PubMed  CAS  Google Scholar 

  63. Katzan IL, Hammer MD, Furlan AJ, et al., on behalf of the Cleveland Clinic Health System Stroke Quality Improvement Team: Quality improvement and tissue-type plasminogen activator for acute ischemic stroke. Stroke 2003, 34:799–800. Implementation of quality improvement programs is crucial to maintaining and enhancing standards. This report shows that the safety of thrombolysis can be improved with proper protocols in place.

    Article  PubMed  CAS  Google Scholar 

  64. Mullins RJ, Mann NC: Population-based research assessing the effectiveness of trauma systems. J Trauma 1999, 47(suppl 3):S59-S66.

    PubMed  CAS  Google Scholar 

  65. Mann NC, Mullins RJ, MacKenzie EJ, et al.: Systematic review of published evidence regarding trauma system effectiveness. J Trauma 1999, 47(suppl_3):S25-S33.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Clinical Neurosciences, University of Calgary, Foothills Hospital, Room 1162, 1403 29th Street NW, T2N 2T9, Calgary, AB, Canada

    James Kennedy MB, MSc, MRCP, Christina Ma BSc & Alastair M. Buchan MB, FRCP(C)

Authors
  1. James Kennedy MB, MSc, MRCP
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christina Ma BSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alastair M. Buchan MB, FRCP(C)
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kennedy, J., Ma, C. & Buchan, A.M. Organization of regional and local stroke resources: Methods to expedite acute management of stroke. Curr Neurol Neurosci Rep 4, 13–18 (2004). https://doi.org/10.1007/s11910-004-0005-9

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11910-004-0005-9

Keywords

Search

Navigation