What are the AHA and the Brain Attack Coalition recommendations for the establishment of specialized stroke centers?

Updated: May 27, 2020
  • Author: Edward C Jauch, MD, MS, FAHA, FACEP; Chief Editor: Helmi L Lutsep, MD  more...
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The concept of the specialized stroke center has evolved in response to the multitude of factors involved in the care of patients with acute stroke. The American Heart Association and the Brain Attack Coalition provided recommendations for the establishment of 3 tiers of stroke centers: acute stroke ready hospitals (ASRHs), primary stroke centers (PSCs), and comprehensive stroke centers (CSCs). [1] The Joint Commission for the Accreditation of Hospital Organizations (JC) and others now provide accreditation for ASRH, PSCs and CSCs. These centers are characterized as follows:

  • ASRH: Designed to address the lack of hospitals typically in rural areas that have the resources to achieve PSC or CSC certification and yet serve as a critical access point for healthcare. Typically they have all the elements of a PSC but lack a physician with stroke expertise and often a dedicated stroke unit. Through the use of telemedicine and teleradiology these centers can evaluate patients for the potential use of fibrinloytics. Key to the optimal function of these stroke centers is their interactions within a regional stroke system of care.

  • PSC: Designed to maximize the timely provision of stroke-specific therapy, including the administration of rt-PA; the center is also capable of providing care to patients with uncomplicated stroke

  • CSC: Shares the commitment that the PSC has to acute delivery of rt-PA and also provides care to patients with hemorrhagic stroke and intracranial hemorrhage, as well as to all patients with stroke who require emergent advanced imaging, intra-arterial therapies, neurosurgical interventions, and management in a neurosurgical intensive care unit (NSICU)

ASRHs, PSCs, and CSCs work most effectively when integrated into a regional stroke system of care so that patients are treated at the most appropriate hospital based on factors such as severity, comorbidities, and timing. Integrating regional prehospital services (911 and EMS) into this system of care ensures the most appropriate triage from the field.

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