Recommendations for the establishment of primary stroke centers
Recommendations for the establishment of primary stroke centers
复制标题
DOI：
10.1001/jama.283.23.3102
复制
发表时间：
2000-06-21
影响因子：
120.7
通讯作者：
Walker, MD
中科院分区：
文献类型：
--
作者：
Alberts, MJ;Hademenos, G;Walker, MD
目的提出建立和运营初级卒中中心的建议，作为改善卒中患者医疗护理的一种方法。脑攻击联盟(BAC)的参与者成员，该联盟是一个由主要专业组织的代表组成的多学科小组，参与提供卒中护理。从参与急性卒中护理的其他专家那里获得补充意见。证据：使用MEDLINE对1966年至2000年3月发表的文献进行回顾。从随机临床试验、荟萃分析、护理指南或其他适当的方法中选择了600多篇英文文章，这些文章支持可纳入卒中中心模型的急性卒中患者的特定护理建议。BAC成员在当前实践参数的背景下审查了每项建议，特别关注改善对急性中风患者的护理、成本效益以及与建立初级中风中心相关的后勤问题。所有BAC参与者在将某一元素添加到推荐列表之前达成了共识。结论随机临床试验和观察性研究表明，中风中心的几个元素将改善患者的护理和预后。初级卒中中心的关键要素包括急性卒中小组、卒中单元、书面护理方案和综合应急系统。重要的支持服务包括每天24小时提供和解释计算机断层扫描，以及快速实验室测试。行政支持、强有力的领导和继续教育也是中风中心的重要因素。采纳这些建议可能会增加适当的诊断和治疗方式的使用，并减少围卒中并发症。建立初级卒中中心有可能改善对卒中患者的护理。
Objective To develop recommendations for the establishment and operation of primary stroke centers as an approach to improve the medical care of patients with stroke.Participants Members of the Brain Attack Coalition (BAC), a multidisciplinary group of representatives from major professional organizations involved with delivering stroke care. Supplemental input was obtained from other experts involved in acute stroke care.Evidence A review of literature published from 1966 to March 2000 was performed using MEDLINE. More than 600 English-language articles that had evidence from randomized clinical trials, meta-analyses, care guidelines, or other appropriate methods supporting specific care recommendations for patients with acute stroke that could be incorporated into a stroke center model were selected.Consensus Process Articles were reviewed initially by 1 author (M.J.A.). Members of the BAC reviewed each recommendation in the context of current practice parameters, with special attention to improving the delivery of care to patients with acute stroke, cost-effectiveness, and logistical issues related to the establishment of primary stroke centers. Consensus was reached among all BAC participants before an element was added to the list of recommendations.Conclusions Randomized clinical trials and observational studies suggest that several elements of a stroke center would improve patient care and outcomes. Key elements of primary stroke centers include acute stroke teams, stroke units, written care protocols, and an integrated emergency response system. Important support services include availability and interpretation of computed tomography scans 24 hours everyday and rapid laboratory testing. Administrative support, strong leadership, and continuing education are also important elements for stroke centers. Adoption of these recommendations may increase the use of appropriate diagnostic and therapeutic modalities and reduce peristroke complications. The establishment of primary stroke centers has the potential to improve the care of patients with stroke.