Elements of a Stroke Center

The past decade has ushered in a refined understanding of-and commitment to-objective evidence-based practice of stroke management. Responding to the need for universal protocol-driven guidelines for stroke care, the Brain Attack Coalition published consensus statements with recommendations for primary stroke centers (Alberts MJ, et al, JAMA 283:3102-3109, 2000) and comprehensive stroke centers (Alberts MJ, et al, Stroke 36:1597-1616, 2005) in 2000 and 2005, respectively. These benchmark publications helped to define a new "standard of care" for stroke patients and laid the groundwork to establish formal certification for stroke centers. Although large randomized controlled trials evaluating the efficacy of these guidelines are currently underway, several recent reports suggest that stroke center certification may improve outcomes in patients with acute ischemic stroke. In this article, the authors briefly discuss the status of stroke center certification and the evolution of stroke systems of care.