The London stroke strategy

doi:10.1136/bmj.b2616

Published 29 June 2009, doi:10.1136/bmj.b2616
Cite this as: BMJ 2009;338:b2616

Letters

Priorities in stroke care

The London stroke strategy

The first 150 words of the full text of this article appear below.

Sudlow and Warlow assume that the benefits of the proposed hyperacutestroke units (HASUs) in London are limited to the delivery ofthrombolysis.¹ However, the aims are to provide all patientswith stroke with emergency assessment from specialists in acutestroke, cost effective brain imaging,² and a high dependencyunit environment for physiological monitoring and active intervention.

The results of the trials of standard stroke units, aspirinand thrombolysis, do not explain the alarming excess mortalityafter stroke in the United Kingdom compared with other westernEuropean countries.³ This difference seems to be associatedwith specialist care and active management of physiologicalvariables.⁴ This model of care and high thrombolysis rates areseen only in large units able to provide 24 hour expert assessment,underpinned by a sufficient number of appropriately trainedand experienced staff. The critical mass of staffing cannotbe provided in every hospital. Sudlow and Warlow’s concentration. . . [Full text of this article]

Nick Losseff, consultant neurologist and interim London clinical director for stroke¹, Diane Ames, consultant stroke physician and joint North West Thames clinical lead for stroke¹, Geoff Cloud, consultant stroke physician and South West Thames clinical lead for stroke¹, Gill Cluckie, stroke clinical nurse specialist and South East Thames clinical lead for stroke¹, Patrick Gompertz, consultant stroke physician and North East Thames clinical lead for stroke¹, Binnie Grant, stroke coordinator and joint North West Thames clinical lead for stroke¹, Hugh Markus, professor of neurology and clinical lead, South East England Stroke Research Network¹, Martin M Brown, professor of stroke medicine and clinical lead, Thames Stroke Research Network¹