ORLANDO, FLA. -- In the past, the brain and heart have received different treatment, at least when it comes to emergencies.
When "code blue" teams rush to someone having a heart attack, their goal is to jump-start the heart to re-establish blood flow to the brain. Such teams have been hospital staples for years; however, the emergence of similar teams to help patients suffering from an equally deadly problem -- stroke -- is only an emerging phenomenon.
It is also a trend that should have started years earlier, according to a Duke University Medical Center neurologist.
"It only makes sense for a team to respond just as quickly to a brain attack as a heart attack -- the goal in both is to begin treatment as soon as possible to minimize the damage to the brain," said Dr. Mark Alberts, who in 1995 called for the creation of acute stroke teams (AST) in a paper in the Annals of Internal Medicine.
ASTs are staffed by specially trained physicians and/or nurses who respond immediately to cases of suspected stroke, whether occurring in patients already in the hospital or newly arrived in the emergency room. More than 500,000 Americans will suffer a stroke each year. Of those, approximately 150,000 will die, making stroke the third leading cause of death and the leading cause of disability.
With the usage of new clot-busting drugs, which, when given within the first three hours of the onset of stroke can reduce and in some cases eliminate the negative impact of stroke, it is crucial to have well-trained teams that can respond quickly to stroke patients.
To determine how the concept has been received in the medical community, Alberts and his colleagues in the National Acute Stroke Team Group conducted a nationwide survey, the results of which were prepared for presentation Thursday (Feb. 5) at the American Heart Association's 23rd International Joint Conference on Cerebral Circulation and Stroke.
Detailed surveys were mailed to 60 directors of major stroke programs and neurovascular experts in the United States; 45 were completed and returned. The results included:
- Ninety-one percent of respondents had ASTs, with two-thirds of them being formed recently -- between 1995 and 1997.
- Sixty-four percent of AST programs cost less than $10,000 per year to operate; 59 percent cost less than $5,000 annually.
- In almost all programs, teams were lead by attending neurologists and/or neurosurgeons.
- In 39 percent of cases, the teams received 2-3 calls per week; 29 percent of teams received more than five calls per week.
- AST staffing consisted of attending physicians (95 percent), nurses or study coordinators (73 percent), fellows (49 percent) and residents (48 percent).
- The large majority, 78 percent, were able to respond to calls within 10 minutes.
"We are very encouraged by the growth in the number of acute stroke teams," Alberts said. "However, the majority of teams tends to be in the nation's academic health centers. Since the majority of stroke patients usually come to community or rural hospitals first, one of our goals is to get the word out that they can benefit from having these teams."
One finding of the survey, which should appeal to smaller hospitals, is the cost, according to Alberts.
"With most programs costing less than $10,000 per year, it should not place a great financial burden on hospitals," Alberts said. "And while we don't have concrete data on the outcomes of patients treated by ASTs, those of us who treat them strongly suspect that patients are benefitting."
While the teams appear to be economical to operate in financial terms, the main commitment by a hospital is the time of its health care staff, Alberts said. Staffing patterns, as illustrated by the survey, should help administrators of community and rural hospitals decide to establish ASTs.
"Officials at many smaller hospitals feel that these teams are staffed primarily by residents and fellows, which are found primarily at academic health centers," Alberts said. "However, the survey showed that almost every team was led by an attending physician. Attending physicians in these hospitals are accustomed to being 'on-call.' Participating in an acute stroke team would be no different. A minority of ASTs are staffed by residents and fellows.
"Since members of the stroke teams will care for the same kinds of patients repetitively, they will get better at treating them," he said.