Author response: Standard operating procedures improve acute neurologic care in a sub-Saharan African setting.

Abstract

We thank Dr. Chin for the comments on our article.1 We agree that the study was performed under experimental conditions. This limitation, aimed to be minimized by assessment conditions that were similar before and after standard operating procedure (SOP) implementation and by the absence of provision of additional resources, was discussed.1 The statement that sub-Saharan African countries face crucial challenges that are, in the end, associated with the severe financial constrains is true. This was documented in our study,1 including the problem of CT performance due to unsettled payment questions. SOPs are only one of several steps, among which are long-term international financial support and cooperation, structural measures (such as health insurance systems), and systematic training of neurologists (thereby avoiding brain drain). Yet, what can be done today? As long as the financial support and the structural frameworks remain suboptimal, SOPs to make better use of the still available, although limited, personnel and technical resources (e.g., adjustment of physiologic measures, aspirin prophylaxis, or physiotherapy) are a relevant step towards guideline-recommended stroke management. As suggested by Dr. Chin, these might be complemented by further SOPs that focus on postemergency management and measures for prevention.2