Early transfer of stroke patients to comprehensive stroke centers: David and Goliath.

Abstract

More than a thousand years ago on a battlefield in ancient Palestine, a shepherd boy (David) defeated a mighty fully armored warrior (Goliath) with a stone and a sling. Comprehensive Stroke Centers (CSC), the Goliath of stroke care, are typically high-volume, more experienced, and more resourced compared with conventional Stroke Units (SU) at community hospitals—David’s.1 Although the benefits from early evaluation and care of stroke patients not candidates for reperfusion therapy are undisputable, their routines transfer to a giant and busy CSC from a small but skilled SU is controversial. Dr Sheth is the Goliath’s manager. He considers that our patient is at high risk for early clinical complications and that triaging such patients to a CSC that has the expertise and resources to manage the anticipated complications is essential. In contrast, Dr Langhorne argues that the best management for our patient is to admit him to a well run SU in the local community, despite …