Do Primary Stroke Centers Occur Randomly?

See related article, p 3717.When the Brain Attack Coalition began to publish recommendations for the development of Stroke Centers, they chose to begin with primary stroke centers (PSCs), in the hope that such centers would impact the largest number of patients in the shortest period of time.1,2 Currently, in the United States, there are >1000 PSCs certified by the Joint Commission, and likely several hundred more certified by other private agencies (ie, Healthcare Facilities Accreditation Program and Det Norske Veritas), as well as some state health departments. Considering there are slightly >5000 acute care hospitals in the country, this means that ≈25% of hospitals in the United States are a PSC. This represents a significant advance in stroke care over a little more than a decade since the Joint Commission began their PSC certification program.As McDonald and colleagues note,3 PSCs are associated with many improved important outcomes (reduced death and disability, higher rates of utilization of intravenous tissue-type plasminogen activator), as well as better compliance with several other stroke care measures as tracked by Get with the Guidelines-Stroke.4,5 It is now common, if not routine, for some cities and some regional emergency medical service providers to divert patients with a suspected acute stroke to the nearest PSC or Comprehensive …