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Primary Stroke Centers may not be good enough anymore

Intro­duction

We have now repre­sented numerous stroke patients and no matter how large a recovery is obtained in their lawsuits, no one has ever said that having the stroke was worth it. Univer­sally every client has said that they would gladly give all of the money back if things could be as they were before the stroke. Stroke is the number one cause of disability in the United States and the number 2 cause of death in the world. Stroke victims who do survive can be left with one or more of the following disabil­ities:  paralysis of an arm and/or leg; diffi­culty speaking; damaged thought processes; and vision problems. This is another in a series of articles we are posting to help our friends and clients avoid becoming involved in a future stroke malpractice lawsuit.

Treating acute stroke patients with clot busters

The clot busting drug tPA causes clots to dissolve. It has been shown to reduce the damaging effects of stroke when given as early as possible after the onset of stroke symptoms. Once 4 ½ hours have passed after a stroke began, tPA is no longer considered safe to give intra­venously. tPA, and every other known treatment to restore blood flow to the brain and prevent future strokes, is more effective the earlier it is started. Public health campaigns such as “Time is Brain,” “Time Lost is Brain Lost,” and “FAST (Facial droop­iness, Arm weakness/numbness, Speech diffi­culties & Time)” were therefore designed to teach the warning signs and symptoms of stroke and emphasize the need for immediate emergency care. Without prompt treatment, many people who suffer an acute stroke will die or be perma­nently disabled.

Since the United States Food & Drug Admin­is­tration approved the clot busting drug tPA in 1996, many states have imple­mented plans that require local Fire Rescue Depart­ments to take patients suffering an acute stroke to the Emergency Department of a certified stroke center hospital. There are two levels of certified stroke centers:  Compre­hensive Stroke Centers and Primary Stroke Centers. As the name implies, Compre­hensive Stroke Centers offer the most advanced treat­ments for stroke, which now includes endovas­cular inter­ven­tions which can physi­cally remove a clot causing a stroke. In contrast, some Primary Stroke Centers do not offer such advanced treat­ments and are limited to offering intra­venous tPA only.

Tremendous improvement in restoring blood flow to the brain of a stroke victim

The results of six studies have been published recently which will dramat­i­cally change acute stroke care in the United States.  First the good news: It has now been defin­i­tively proven that patients suffering the type of acute ischemic stroke that produces the most devas­tating disabil­ities fare much better when they undergo endovas­cular inter­vention after they have been given tPA intra­venously.  (Endovas­cular inter­vention involves removing the clot that is the stroke with a tiny tool that is advanced into the affected artery.) One of these studies had early results that was so overwhelm­ingly successful that the study was halted early so that the results could be immedi­ately incor­po­rated into current stroke care. These studies have resulted in the issuance of updated guide­lines for the management of patients suffering a stroke caused by a clot in the brain.

Emergency Medicine physi­cians no longer endorse aggressive use of clot busters

Now the bad news. In late June, the American College of Emergency Physi­cians, an organi­zation consisting of the first doctors who will see acute stroke patients taken to the Emergency Department of a Primary Stroke Center, published new guide­lines tempering the aggressive use of tPA by its members. The new guide­lines were a departure from an earlier version issued in 2013 that were developed with the American Academy of Neurol­o­gists which endorsed the aggressive use of tPA in the treatment of acute ischemic stroke. In response to overwhelming objec­tions raised by a majority of the ACEP’s membership to the 2013 guide­lines, the ACEP released the new guide­lines without the input of the neurol­o­gists – the experts in treating patients suffering an acute stroke. Clearly, the Emergency Room doctors and the stroke specialists are going in different direc­tions when it comes to stroke care.

How can an acute stroke victim get the best care?

All Compre­hensive Stroke Centers offer tPA and endovas­cular inter­ven­tions; however, not all Primary Stroke Centers offer endovas­cular inter­vention. If you, or a loved one, begin exhibiting the warning signs of stroke, insist on being immedi­ately taken to a Compre­hensive Stroke Center. This link will help you locate the closest Compre­hensive Stroke Care Center to your home.

Matt Sowell is a Board Certified Civil Trial Lawyer who focuses his practice on medical malpractice and catastrophic personal injury claims, partic­u­larly those where the client has suffered a stroke. Matt is a national leader in stroke litigation, having served as the founding chairman of the Stroke Litigation Group of the largest organi­zation of trial attorneys in the United States.

Refer­ences:

Clot-removal devices now recom­mended for some stroke patients.

Breaking News: ACEP – Minus the Neurol­o­gists – Tempers its tPA Policy.