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November 2016

Is a Neurologist Needed to Diagnose Acute Stroke in the Emergency Department?Too Many Cooks Might Spoil the Broth

Author Affiliations
  • 1Division of Neurology, Department of Medicine, University of South Carolina School of Medicine, Greenville
JAMA Neurol. 2016;73(11):1273-1274. doi:10.1001/jamaneurol.2016.2527

Stroke is a leading cause of death and disability. In acute ischemic stroke, urgent thrombolysis with tissue plasminogen activator (tPA) is the treatment of choice after exclusion of intracerebral hemorrhage by brain imaging. If treatment outcomes are divided into 90-minute epochs, a patient who receives tPA in the first 90 minutes has the highest probability of the best outcome.1 The current model of triage and treatment of acute stroke patients includes a posse of paramedics, nurse practitioners, radiologists, emergency physicians, and neurologists and is an antiquated model whose time has come—the neurologist has to go. Acute stroke care triage and evaluation are as close to the concept of “cookbook medicine” as one can get. Computers maul us at chess and IBM’s “Watson” won Jeopardy!—so what is sacrosanct about following an algorithm?

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