J Korean Med Assoc.  2009 Apr;52(4):327-333. 10.5124/jkma.2009.52.4.327.

Organization of Stroke Care System: Stroke Unit and Stroke Center

• Rha JH

• KMID: 2137717
• DOI: http://doi.org/10.5124/jkma.2009.52.4.327

Abstract

The acute management of ischemic stroke consists of several components: general supportive care, thrombolysis, antithrombotics, prevention of medical and neurologic complications, rehabilitation, and if necessary, surgical intervention. However, for the adequate stroke care, not only the medical treatment but also the proper organization of each stroke care component is essential. This includes public education, well organized emergency medical referral system, pre-hospital identification tool of stroke, operation of stroke unit with quality improvement activity, and establishment of stroke center. The efficacy of stroke unit for the acute management of stroke was found to exceed those of conventional medical treatment such as antiplatelet therapy, and now stroke unit is considered to be the key element of acute stroke care. For the harmonious orchestration of these stroke care elements, there is growing need for the establishment of stroke center too. In this review, each component of stroke care is discussed.

Keyword

Stroke; Organization; Stroke unit; Stroke center

MeSH Terms

Emergencies
Quality Improvement
Referral and Consultation
Stroke

Figure

• 

  Figure 1 Network of Stroke Center. Patients can arrive at stroke centers or hospitals either directly or by transfer. Ideally, stroke patients must visit stroke center directly.

Reference

1. Kidwell CS, Liebeskind DS, Starkman S, Saver JL. Trends in acute ischemic stroke trials through the 20th century. Stroke. 2001. 32:1349–1359.

2. Morris DL, Rosamond W, Madden K, Schultz C, Hamilton S. Prehospital and emergency department delays after acute stroke: The Genentech stroke presentation survey. Stroke. 2000. 31:2585–2590.

3. 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.

4. Morgenstern LB, Staub L, Chan W, Wein TH, Bartholo-mew LK, King M, Felberg RA, Burgin WS, Groff J, Hickenbottom SL, Saldin K, Demchuk AM, Kalra A, Dhingra A, Grotta JC. Improving delivery of acute stroke therapy: The TLL temple foundation stroke project. Stroke. 2002. 33:160–166.

5. Morgenstern LB, Gonzales NR, Maddox KE, Brown DL, Karim AP, Espinosa N, Moye LA, Pary JK, Grotta JC, Lisabeth LD, Conley KM. A randomized, controlled trial to teach middle school children to recognize stroke and call 911: The kids identifying and defeating stroke project. Stroke. 2007. 38:2972–2978.

6. Kothari RU, Pancioli A, Liu T, Brott T, Broderick J. Cincinnati prehospital stroke scale: Reproducibility and validity. Ann Emerg Med. 1999. 33:373–378.

7. Nazliel B, Starkman S, Leigeskind DS, Ovbiagele B, Kim D, Sanossian N, Ali L, Buck B, Villablanca P, Vinuela F, Duckwiler G, Jahan R, Saver JL. A brief prehospital stroke severity scale identifies ischemic stroke patients harboring persisting large arterial occlusions. Stroke. 2008. 39:2264–2267.

8. Morgenstern LB, Bartholomew LK, Grotta JC, Staub L, King M, Chan W. Sustained benefit of a community and professional intervention to increase acute stroke therapy. Arch Intern Med. 2003. 163:2198–2202.

9. Stroke Unit Trialists' Collaboration. Organised inpatient (stroke unit) care for stroke. Cochrane Database of Systematic Reviews. 2007. (Issue 4):Art No: CD000197.

10. Langhorne P, Dey P, Woodman M, Kalra L, Wood-Dauphi-nee S, Patel N, Hamrin E. Is stroke unit care portable? A systematic review of the clinical trials. Age Ageing. 2005. 34:324–330.

11. Han MK, Heo JH, Rha JH, Bae HJ, Yoon BW. Recommendations for the establishment of stroke unit in Korea. Korean J Stroke. 2008. 10:72–75.

12. Douglas VC, Tong DC, Gillum LA, Zhao S, Brass LM, Dostal J, Johnston SC. Do the brain attack coalition's criteria for stroke centers improve care for ischemic stroke? Neurology. 2005. 64:422–427.

13. Govan L, Langhorne P, Weir CJ. Does the prevention of complications explain the survival benefit of organized inpatient (stroke unit) care?: Further analysis of a systematic review. Stroke. 2007. 38:2536–2540.

14. Schwamm LH, Pancioli A, Acker JE III, Goldstein LB, Zorowitz RD, Shephard TJ, Moyer P, Gorman M, Johonston SC, Duncan PW, Gorelick P, Frank J, Stranne SK, Smith R, Federspiel W, Horton KB, Magnis E, Adams RJ. American Stroke Association's Task Force on the Development of Stroke Systems. Recommendations for the establishment of stroke systems of care: recommendations from the American Stroke Association's Task Force on the Development of Stroke Systems. Stroke. 2005. 36:690–703.

15. Adams HP Jr, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, Grubb RL, Higashida RT, Jauch EC, Kidwell C, Lyden PD, Morgenstern LB, Qureshi AI, Rosenwasser RH, Scott PA, Wijdicks EF. Guidelines for the early mana-gement of adults with ischemic stroke: A guideline from the American Heart Association/American Stroke Association stroke council, clinical cardiology council, cardiovascular radiology and intervention council, and the atherosclerotic peripheral vascular disease and quality of care outcomes in research interdisciplinary working groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke. 2007. 38:1655–1711.

16. Alberts MJ, Hademenos G, Latchaw RE, Jagoda A, Marler JR, Mayberg MR, Starke RD, Todd HW, Viste KM, Girgus M, Shephard T, Emr M, Shwayder P, Walker MD. Brain attack coalition. Recommendations for the establishment of primary stroke centers. JAMA. 2000. 283:3102–3109.

17. Alberts MJ, Latchaw RE, Selman WR, Shephard T, Hadley MN, Brass LM, Koroshetz W, Marler JR, Booss J, Zorowitz RD, Croft JB, Magnis E, Mulligan D, Jagoda A, O'Connor R, Cowley CM, Connors JJ, Rose-DeRenzy JA, Emr M, Warren M, Welker MD. Brain Attack Coalition. Recommendations for comprehensive stroke centers: a consen-sus statement from the Brain Attack Coalition. Stroke. 2005. 36:1597–1616.

18. Recommendations for improving the quality of care through stroke centers and systems: an examination of stroke center identification options: multidisciplinary consensus recommendations from the Advisory Working Group on Stroke Center Identification Options of the American Stroke Association. Stroke. 2002. 33:e1–e7.

19. Choi HY, Cho HJ, Kim SH, Han SW, Nam HS, Lee JY, Ahn SH, Heo JH. Organization and Operation of Stroke Unit. Korean J Stroke. 2006. 8:171–178.

20. Seo JH, Choi HY, Cho HJ, Heo JH. Beneficial Effect of Stroke Unit for Detection of Atrial Fibrillation. Korean J Stroke. 2007. 9:37–41.

21. Rha JH, Heo JH, Bae HJ, Han MK, Yoon BW. Recommendations for the Establishment of Stroke Center in Korea. Korean J Stroke. 2008. 10:67–71.