Intervention Progress


A new study of patients with ischemic stroke (JAMA. 2011;305:373-380) found that those admitted to hospitals certified as primary stroke centers had a modestly lower risk of death and serious disability.

Ying Xian, MD, PhD, of the Duke Clinical Research Institute in Durham, N.C., and colleagues compared mortality rates for 30,000 stroke patients in a New York state database, half of them admitted to certified stroke centers and the rest to nondesignated hospitals. Overall 30-day, all-cause mortality was 10.1% for the former group, 12.5% for the latter.

But this modestly lower death rate is still important, says Mark J. Alberts, MD, director of the stroke program at Northwestern University Feinberg School of Medicine in Chicago. "There aren't that many interventions we do in modern medical care that actually prevent death."

In an editorial accompanying the JAMA stroke study, Dr. Alberts portrays an emerging, multitiered system of stroke care, "with the comprehensive stroke center at the top of the pyramid, the primary stroke center in the middle, and the acute stroke-ready hospital at the base." He compares this emerging system to trauma care, which has Level 1 trauma centers at the top of its pyramid.

Not every hospital within a region might be able to pursue stroke center certification, or even become more stroke-ready, he says. But hospitals could work collaboratively to create regional stroke referral networks based on the distribution of patients and resources. Hospitalists can help promote such networks (see The Hospitalist, December 2009). "I would start by knowing your patient population, how many stroke patients present at your hospital each year," he explains.

"The overriding concept is to get stroke patients as efficiently and safely as possible to the hospital that can provide them with the most appropriate level of care," Dr. Alberts says.

More than 800 U.S. hospitals are certified as primary stroke centers by the Joint Commission. While there are not yet formal standards or requirements for an acute-stroke-ready hospital, the term suggests mobilizing resources, capabilities and expertise to receive stroke patients, stabilize them, and send them to the most appropriate facilities based on their medical needs.

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