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Stroke centre or local hospital? In an emergency just call 911!

The Bottom Line

  • Specialized stroke centres are widely believed to be the best choice for people experiencing a stroke.
  • When every second counts, your closest local hospital may be the best place for emergency care, provided it is equipped to deliver “clot-busting” (thrombolysis) treatment.
  • Think it’s a stroke? Not sure where to go? The only call you need to make is 911! Be aware of the signs and act fast to ensure the best possible recovery.

Taking your time is the smart way to go in many instances. But a medical emergency like a stroke is NOT one of them. In fact, that’s when it’s critical to act quickly and without hesitation.


Stroke is the second leading cause of death and the third leading cause of disability worldwide (1;2;3). That’s alarming but there is encouraging news: advances in the diagnosis, treatment and aftercare of acute ischaemic stroke (the most common kind that happens when a clot stops blood from getting to a part of the brain) have saved countless lives (4).


A turning point in emergency care for ischemic stroke came with the introduction of “clot busting” treatment called thrombolysis in which the drug tPA (Tissue Plasminogen Activator) is injected to dissolve the clot and restore blood flow (5). It works well but there is a catch: the drug must be given as quickly as possible (ideally within 3 hours) after the appearance of stroke symptoms in order to save the patient from serious brain damage, or even death (6).


Designated stroke centres have become the new standard of care in many countries (3). They provide coordinated prevention, acute care, rehabilitation and continuing care services delivered by a medical team of specialists and are considered by many experts to be the best option for stroke patients (3;4;6). That’s why people suffering a stroke may be taken by ambulance to a specialist stroke centre, even if it’s farther away than the patient’s local hospital.


That would seem to be at odds with the goal of having stroke victims treated as soon as possible so a recent systematic review attempted to find out whether emergency care in specialized stroke centres does indeed save more lives (7). Fourteen studies were included in the review. They compared death rates for 2,790 stroke patients, some of whom were taken directly to a designated stroke centre while others received emergency treatment at a local hospital.


What the research tells us

Although there were not many high quality studies available on this topic to allow strong conclusions, the best evidence we have right now shows that it is the clot busting treatment that matters, not the location. Death rates were no different between the two groups when the patient’s local hospital provided thrombolysis, and both sets of patients experienced about the same rate of recovery and risk of complications (7).


In other words, your local hospital may be just as good as a stroke centre in an emergency, provided it is equipped to deliver thrombolysis. Patients can later be transferred to a stroke centre for recovery and rehabilitation with specialized and coordinated medical care – as was the case for this study’s participants. More high quality research will allow us to make more confident recommendations about emergency stroke care in the future.


In the meantime, if you think you may be having a stroke, or you suspect someone else is, don’t waste time wondering where to go – call 911 and leave it to the emergency personnel to get you to the right place as quickly as possible.


Know the signs of stroke 

Check out the Heart & Stroke Foundation’s stroke awareness tips. Share these with your family, friends, neighbours and colleagues. The more people who know what to do in an emergency, the better for all of us!


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References

  1. Lozano R, Naghavi M, Foreman K et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012; 380:2095-128.
  2. Murray CJL, Vos T, Lozano R et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012; 380:2197-223.
  3. Stroke Unit Trialists' Collaboration. Organised inpatient (stroke unit) care for stroke. Cochrane Database Syst Rev. 2013; 9:1-99.
  4. Singh V, Edwards NJ. Advances in the critical care management of ischemic stroke. Stroke Res and Treat. 2013; 1-7.
  5. Tissue plasminogen activator for acute ischaemic stroke. The National Institute of Neurological Disorders and Stroke re-PA Stroke Study Group. N Engl J Med. 1995; 333:1581-1587.
  6. National Institute for Health and Clinical Excellence. Alteplase for the treatment of acute ischaemic stroke. [Internet] 2012. [cited Feb 2016]. Available from: http://www.nice.org.uk/guidance/ta264/resources/alteplase-for-treating-acute-ischaemic-stroke-review-of-technology-appraisal-guidance-122-82600551992005 
  7. Pickering A, Harnan S, Cooper K et al. Acute ischaemic stroke patients – direct admission to a specialist centre or initial treatment in a local hospital? A systematic review. J Health Serv Res Policy. 2015 DOI: 10.1177/13558.

DISCLAIMER: The blogs are provided for informational purposes only. They are not a substitute for advice from your own healthcare professionals.

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