From the moment a person starts to experience stroke symptoms, the clock starts ticking.
Every minute that passes can make a difference in how well their brain, arms, legs, speech or thinking ability recover.
Now, new national guidelines for stroke treatment -- co-authored by a member of the University of Michigan Comprehensive Stroke Program -- make it clear just how much minutes count. They also lay out a role for all types of hospitals in treating stroke emergencies, including community hospitals of the type involved in a recent U-M led study of stroke care.
The American Stroke Association guidelines are published in the American Heart Association journal Stroke. The authors include Phillip Scott, M.D., a U-M emergency physician and member of the U-M Comprehensive Stroke Program.
Here are some key numbers:
Air medical transport and telemedicine support from large stroke-center hospitals such as U-M should be used to supplement the care any particular hospital can provide, the guidelines say.
The new guidelines recommend integrating regional networks of comprehensive stroke centers (which offer 24/7, highly specialized treatment for all types of stroke); primary stroke centers (which provide 24/7 specialized care mainly for ischemic stroke); and acute stroke-ready hospitals (which can evaluate and treat most strokes but lack highly specialized capabilities), and community hospitals.
Among other major revisions to the guidelines: If feasible, patients should be rapidly transferred to the closest available certified primary care stroke center or comprehensive stroke center, which might involve air medical transport.
"However, for patients brought to hospitals that don't offer specialized stroke expertise, telemedicine and simple telephone support can provide real-time access to that expertise," says Scott. "If such a hospital partners with a primary or comprehensive stroke center, early treatment decisions can be made to treat patients."
Scott has directed a 24-hospital research effort, called INSTINCT (funded by the National Institute of Neurological Diseases and Stroke) that evaluated the ability of community hospitals to deliver stroke treatment safely and effectively, with training and 24/7 support available from U-M.
Other key recommendations in the new guidelines include:
Co-authors of the guidelines are: Jeffrey L. Saver, M.D.; Harold P. Adams Jr., M.D.; Askiel Bruno, M.D., M.S.; J. J. (Buddy) Connors, M.D.; Bart M. Demaerschalk, M.D., M.Sc.; Pooja Khatri, M.D.; Paul W. McMullan Jr., M.D.; Adnan I. Qureshi, M.D.; Kenneth Rosenfield, M.D.; Phillip A. Scott, M.D.; Debbie Summers, R.N., M.S.N.; David Z. Wang, D.O.; Max Wintermark, M.D.; and Howard Yonas, M.D.
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