In the absence of evidence we should manage acute stroke as a medical emergency

In the United Kingdom government's targets for health improvement stroke is an also ran after cardiovascular disease and is subsumed into the national service framework for older people.1 Gross inequity exists in the provision of stroke services within the UK, and comparisons with mainland Europe show Britain in a poor light. 2 3 These statistics are of concern as the impact of stroke is set to increase. UK incidence data have been used to estimate that there will be a 30% absolute increase in the number of patients experiencing a first ever stroke in 2010 compared with 1983.4

In a recent population based study of survival after stroke in a London population compared with two central European populations survival in London was significantly worse after adjustment for demographic and casemix factors.5 In a separate European hospital based study comparing 12 centres in seven countries similar poor survival rates were observed in UK centres after adjustment for casemix and demographic factors.9 Furthermore, in the International Stroke Trial UK centres had the poorest survival rates in the world.6 …