Future Perspectives of Organised Stroke Care

Ritter MA, Dittrich R, Busse O, Nabavi DG, Ringelstein EB

Abstract

The state-of the art management of stroke patients is treatment on a certified stroke unit. Demographical changes and increasing morbidity will increase both, the number of stroke patients and the complexity of the cases. Increasing patient numbers in an era of economical restraints require highly effective services. The \"stroke unit\" concept will be diversified in the future to serve stroke patients on various levels: basic stroke units, stroke centres and comprehensive stroke units will be established, in some big hospitals Neurovascular centres will be implemented in which highly complex cases can be treated in quite high numbers. The strict separation of the inpatient and the outpatient treatment in Germany will be broken up by centres that deliver integrated stroke services. Telemedicine will play a growing role in stroke medicine. Telemedicine wil be used as part of the acute treatment by teleconsults and teleradiology. Furthermore, exchange of patient data by fast and secure internet lines, e.g., for cerebral imaging or external ECG analysis to detect atrial fibrillation, will be used more extensively. The demand for neuroradiological interventions will increase. Therefore it will be mandatory to define clear indications as to which patients are likely to benefit from complex and costly procedures. The indications and costs for pre-hospital stroke services such as the STEMO will have to be defined.