Intensive care for acute stroke in the community hospital setting. The first 24 hours.

Controversy continues over the value of dedicated "stroke units" since improved outcome in patients treated in such units has not been demonstrated. For most hospitals a specialized stroke unit would not be feasible even if effective. We have provided neurological consultation for stroke patients at all 16 acute care hospitals in Cincinnati. Only two hospitals have neurology/ neurosurgery intensive care units, but the remaining 14 hospitals have fully equipped medical intensive care units with on-site availability of emergency computed tomography and emergency cerebral angiography. At these hospitals and other hospitals nationally, high-quality intensive care can be provided to stroke patients outside of a specialized unit. Standards of care can be developed that offset varying capabilities for highly specialized neurological monitoring.