NINDS Symposium Produces National Plan for Rapid Stroke Treatment

For release: Friday, December 13, 1996

For many of the 500,000 people who suffer a stroke each year, today will mark the beginning of a significant change in the way they receive medical care.

Today in Washington, D.C., the National Institute of Neurological Disorders and Stroke (NINDS) hosted an unprecedented gathering of more than 50 organizations involved in the diagnosis, care, and treatment of acute stroke. At the National Symposium on Rapid Identification and Treatment of Acute Stroke, more than 400 medical professionals from neurology, emergency medicine, radiology, internal medicine, neurosurgery, nursing, and other fields within the health care system laid the foundation for a national plan for rapid stroke treatment.

"We're entering a new era in the treatment of stroke, prompting major changes in medical practice along the entire spectrum of the health care system," according to NINDS director Zach W. Hall, Ph.D. "NINDS was proud to announce the first effective treatment for acute stroke last December, but this and other treatments now being developed for stroke demand rapid and immediate intervention to be effective. This symposium represents the next step in meeting this important challenge."

The symposium participants developed a blueprint in the following areas: pre-hospital emergency medical care systems, emergency department response to stroke, acute hospital care, health care systems and public education.

Experts in pre-hospital emergency systems stressed that there are multiple time-critical steps along the route to getting stroke patients the kind of care that will increase their chances of leaving the hospital without disability. Describing it as "the chain of recovery," the experts noted that the key links for ensuring successful acute stroke care include:

* rapid identification of stroke symptoms coupled with timely response by those who experience or witness the onset of stroke * quick access to emergency medical assistance (e.g., medically-supervised 9﷓1﷓1 dispatchers) * rapid response, treatment and transport by emergency medical services (EMS) to appropriate treatment centers * rapid diagnosis and intervention at these centers * specialized treatment and evaluation for complications and precipitating factors * appropriate rehabilitation when applicable.

Paul E. Pepe, M.D., M.P.H., of Allegheny General Hospital in Pittsburgh, chairman of the panel on Pre-hospital Emergency Medical Care Systems, emphasized the need to consider stroke a time-critical emergency condition which demands the same rapid attention as heart attack and trauma. He added that there must be new educational initiatives for all emergency providers.

The Emergency Department panel recommended that hospitals that treat acute stroke patients with clot-dissolving or similar drugs should focus their efforts so that the drug is received within one hour of the patient's arrival at the emergency department. A coordinated multidisciplinary team, including emergency medical services personnel, nurses, and physicians in a number of specialties is critical to achieving this goal, says William G. Barsan, M.D., of the University of Michigan in Ann Arbor, a keynote speaker at the symposium. Educating these health care personnel on the natural course of stroke is also critical, as is evaluating their services.

The Acute Hospital Care panel, led by Anthony J. Furlan, M.D., of the Cleveland Clinic Foundation, agreed that every hospital that cares for patients with acute stroke needs a stroke plan. The panel said the plan should cover stroke care from pre-hospital recognition through discharge and should address ways to prevent a second stroke. Hospitals should use evidenced-based guidelines to develop their stroke plans. A stroke "toolbox" containing these guidelines and sample plans should be created, updated and made easily available.

Since the first effective treatment for acute ischemic stroke was approved last June, only a handful of hospitals have developed stroke teams and plans to quickly treat stroke patients. The NINDS symposium panel on Health Care Systems, led by Thomas C. Royer, M.D., of the Henry Ford Medical Group, supported the notion that best possible care of the patient should be the primary goal of any system. They also recommended that hospitals strive to provide quality stroke care with minimal risk to the highest number of patients.

The Public Education Panel, led by Judith A. Spilker, R.N., of the University of Cincinnati, recommended that the public education activities of the many voluntary and professional organizations involved in stroke could best be coordinated at a national level with the leadership of the NINDS. This leadership group should develop a strategic plan to arrive at a simple, effective public awareness message. The panel also identified the value of central access to information on how to prevent and treat stroke for the both public and health professionals. The panel pointed out that public education is an ongoing process that will take many years to be successful. Any fears that a national public awareness program would overwhelm the resources and abilities of emergency departments are unfounded, they said.

"The goal of the symposium is to publish a document to guide community health professionals who are seeking successful strategies for rapid treatment of stroke," said Michael D. Walker, M.D., Director of the NINDS Division of Stroke, Trauma and Neurodegenerative Disorders. "It is our belief that all stroke patients will receive better medical care if they are seen early, even if they are not eligible for this new treatment," he said.

"This symposium is a signal that the field is moving to make the changes required to treat stroke rapidly. We have one treatment in hand and others in the pipeline. The ultimate goal is to reduce the high rates of death and disability caused by stroke in this country," said John R. Marler, M.D., Medical Officer, NINDS Division of Stroke, Trauma and Neurodegenerative Disorders.

The NINDS, one of the National Institutes of Health located in Bethesda, Maryland, is the nation's leading supporter of research on the brain and nervous system and a lead agency for the Congressionally designated Decade of the Brain.

Originally prepared by Stephanie Clipper, NINDS Office of Communications and Public Liaison.

Date Last Modified: Tuesday, March 08, 2005

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