Acute ischaemic stroke patients – direct admission to a specialist centre or initial treatment in a local hospital? A systematic review

ObjectivesTo assess the clinical effectiveness, in acute ischaemic stroke patients, of bypassing non-specialist centres in preference for a specialist stroke centre to receive the time-critical intervention of thrombolysis.MethodsSystematic review and meta-analysis using: MEDLINE; MEDLINE In-Process; EMBASE; CINAHL; Cochrane Library including Cochrane Database of Systematic Reviews, Cochrane CENTRAL Controlled Trials Register, DARE, NHS EED and HTA databases. Studies were included if they compared acute ischaemic stroke patients directly triaged to a specialist centre versus those initially triaged to a non-specialist centre with some or all later transferred to a specialist centre. Studies were excluded if they compared patients ever treated in a specialist centre versus those never treated in such a centre, since the aim was to assess the optimum initial triage route rather than the optimum location for overall management. The assumption being, based on previous research, that management in a specialist...