Translational Science and Molecular Medicine, Michigan State College of Human Medicine, Michigan, USA. ; Hauenstein Neuroscience Center, Saint Mary's Health Care, Michigan, USA.
J Stroke. 2013 May;15(2):78-89. doi: 10.5853/jos.2013.15.2.78. Epub 2013 May 31.
In the United States (US) stroke care has undergone a remarkable transformation in the past decades at several levels. At the clinical level, randomized trials have paved the way for many new stroke preventives, and recently, several new mechanical clot retrieval devices for acute stroke treatment have been cleared for use in practice by the US Federal Drug Administration. Furthermore, in the mid 1990s we witnessed regulatory approval of intravenous recombinant tissue plasminogen activator for administration in acute ischemic stroke. In the domain of organization of medical care and delivery of health services, stroke has transitioned from a disease dominated by neurologic consultation services only to one managed by vascular neurologists in geographical stroke units, stroke teams and care pathways, primary stroke center certification according to The Joint Commission, and most recently comprehensive stroke center designation under the aegis of The Joint Commission. Many organizations in the US have been involved to enhance stroke care. To name a few, the American Heart Association/American Stroke Association, Brain Attack Coalition, and National Stroke Association have been on the forefront of this movement. Additionally, governmental initiatives by the US Centers for Disease Control and Prevention and legislative initiatives such as the Paul Coverdell National Acute Stroke Registry program have paved the way to focus on stroke prevention, acute treatment and quality improvement. In this invited review, we discuss a brief history of organized stroke care in the United States, evidence to support the value of primary and comprehensive stroke centers, and the certification criteria and process to become a primary or comprehensive stroke center.
在美国，过去几十年间，在多个层面上，卒中护理都发生了显著变化。在临床层面，随机试验为许多新的卒中预防措施铺平了道路，最近，几种新的机械取栓装置已获得美国联邦药物管理局批准用于急性卒中治疗。此外，在 20 世纪 90 年代中期，我们见证了静脉内重组组织型纤溶酶原激活物用于急性缺血性卒中的监管批准。在医疗保健组织和卫生服务提供领域，卒中已从仅由神经科会诊服务主导的疾病转变为由地理性卒中单元、卒中团队和护理路径中的血管神经科医生管理的疾病，根据联合委员会进行初级卒中中心认证，以及最近在联合委员会的支持下进行综合卒中中心指定。美国的许多组织都参与了提高卒中护理水平的工作。仅举几例，美国心脏协会/美国卒中协会、脑卒中国际联盟和国家卒中协会一直处于这一运动的前沿。此外，美国疾病控制与预防中心的政府倡议以及《保罗·克劳德尔国家急性卒中登记计划》等立法倡议为关注卒中预防、急性治疗和质量改进铺平了道路。在这篇特邀综述中，我们讨论了美国有组织的卒中护理的简要历史、支持初级和综合卒中中心价值的证据，以及成为初级或综合卒中中心的认证标准和流程。
