By Pam Hollsten, RN, BSN, LNCC
© The Medical-Legal News 2007
Stroke remains a leading cause of death and significant disability in the U.S. , and can be the focus of a medical malpractice case. A stroke can be classified as ischemic (clot type) or hemorrhagic (bleeding type). Depending on the etiology, either from a thrombus or embolus, or a bleeding source, the applicable standard of care for diagnosis, treatment and prognosis for recovery can be very different.
Additional medical conditions that may need to be investigated in relation to the etiology or prevention of strokes include the management of atrial fibrillation, hypertension and transient ischemic attacks. There remains controversy in the appropriateness and effectiveness with utilizing tPA (tissue plasminogen activator) in the management of ischemic strokes. To date, there is no published consensus on the use of tPA as the standard of care among emergency physicians and neurologists, despite the emergence of primary stroke centers certified by JCAHO (Joint Commission on Accreditation of Healthcare Organizations) and criteria set forth by the BAC (Brain Attack Coalition).
The following references and resources provide a starting point for nurse consultants and attorneys when evaluating a potential case involving strokes.
• National Stroke Association: http://www.stroke.org/site/PageServer?pagename=HOME; information for emergency medicine, healthcare professionals and stroke survivors; regular updates on clinical trials and research in the care and treatment of strokes.
• Stroke: http://stroke.ahajournals.org/; online access to current and archived issues of Stroke and publications from other American Heart Association journals; contains links to current scientific statements and practice guidelines from the AHA.
• American Heart Association: http://www.americanheart.org/presenter.jhtml?identifier=3004586; links to guidelines from 1994 to the present time on the topic of stroke, TIA, aneurysms, medications and rehabilitation.
• American Stroke Association: http://www.strokeassociation.org; American Stroke Association’s website with access to professional resources, statistics, continuing medical education and conferences.
• National Institute of Neurological Disorders and Stroke: http://www.ninds.nih.gov/disorders/stroke/stroke.htm; NINDS web site contains publications, organizations, research and press releases pertaining to neurological disease and stroke.
• MedlinePlus Medical Encyclopedia: Stroke: http://www.nlm.nih.gov/medlineplus/ency/article/000726.htm; overview of strokes with illustrations detailing brain structures and vasculature involved in various types of strokes, differential diagnoses and explanation of diagnostic testing.
• The Stroke Center : http://www.strokecenter.org/prof/guidelines.htm; contains comprehensive list of links to guidelines, consensus statements and professional publications on stroke, stroke prevention, diagnosis, imaging and stroke centers.
• ACEP: Use of Intravenous tPA for the Management of Acute Stroke in the Emergency Department:http://www.acep.org/webportal/PracticeResources/issues/clin/UseIntravenoustPAManagementAcuteStrokeED.htm; American College of Emergency Physicians’ policy resource and education paper reviewing the literature published on the topic of the use of IV tPA for acute stroke.
• ACEP: Policy Statement: Use of Intravenous tPA for the Management of Acute Stroke in the Emergency Department:http://www.acep.org/webportal/PracticeResources/PolicyStatements/pracmgt/UseofIntravenoustPAforAcuteStroke.htm.
• SAEM: Position Statement: Optimizing Care of the Stroke Patient:http://www.saem.org/saemdnn/AboutSAEM/Governance/PositionStatements/OptimizingCareoftheStrokePatient/tabid/173/Default.aspx; Society for Academic Emergency Medicine’s position statement on the use of thrombolytic therapy and optimizing care of the stroke patient.
• JCAHO: Primary Stroke Centers: http://www.jointcommission.org/CertificationPrograms/PrimaryStrokeCenters/; Joint Commission’s link to certification program information for primary stroke center designation and stroke performance measurement guides.
• AAEM: Position Statement on Thrombolytic Therapy: http://www.aaem.org/positionstatements/thrombolytictherapy.php;American Academy of Emergency Medicine’s position statement on the use of intravenous thrombolytic therapy in the treatment of stroke.
• American Academy of Neurology Special Article: http://www.neurology.org/cgi/reprint/59/1/13.pdf; link to AAN’s Report of the Joint Stroke Guideline Development Committee of the American Academy of Neurology and the American Stroke Association on the topic of anticoagulants and antiplatelet agents in the management of acute ischemic stroke.
• Acute Stroke Treatment. Bogousslavsky, Julien, editor. Informa Healthcare; 2nd edition (2003).
• Adams and Victor’s Principles of Neurology. Ropper, Allan H., Brown, Robert H. McGraw-Hill Professional; 8th edition (2005).
• Cerebrovascular Ultrasound in Stroke Prevention and Treatment. Alexandrov, Andrei V., editor. Blackwell Publishing Limited; 1st edition (2004).
• Critical Care Neurology and Neurosurgery. Suarez, Jose I., editor. Humana Press; 1st edition (2004).
• Current Therapy in Neurologic Disease. Johnson, Richard T., et al. C. V. Mosby; 6th edition (2002).
• Handbook of Stroke Prevention in Clinical Practice. Furie, Karen L., Kelly, Peter K., editors. Humana Press; 1st edition (2004).
• Stroke: Pathophysiology, Diagnosis and Management. Mohr, J. P., et al. Churchill Livingstone; 4th edition (2004).
• Stroke Syndromes. Bogousslavsky, Julien, Caplan, Louis R., editors. Cambridge University Press; 2nd edition (2001).
• Stroke Therapy. Fisher, Marc, editor. Butterworth-Heinemann; 2nd edition (2001).
• Textbook of Neurointensive Care. Layon, Joseph, et al. Saunders; 1st edition (2003).
• Thrombolytic Therapy for Stroke. Lyden, Patrick D. Humana Press; 1st edition (2001). •
Pam Hollsten, RN, BSN, LNCC is a legal nurse consultant with over ten years experience in medical malpractice and catastrophic personal injury cases.
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