European Stroke Organisation recommendations to establish a stroke unit and stroke center.

Acute stroke care in hospitals is best performed in organized stroke units, which are the essential part of the chain of recovery and form the backbone of prehospital, in-hospital, and posthospital care, that is, from home back to home. There is convincing evidence from a large number of randomized controlled trials that the outcomes of stroke and transient isch-emic attack (TIA) patients managed in dedicated stroke units are better than those of patients managed in general medical or neurological wards. The stroke unit model tested in randomized controlled trials forms the key basic measure of stroke service quality. More refined infrastructures have also been developed for acute diagnostics and treatment but are not defined as absolute requirements because of less substantiated evidence and higher dependence on resources. The chain of care for TIA and stroke patients requires immediate recognition of the stroke symptoms by the patient and his environment, rapid and well-organized prehospital paramedical support, including transportation and prehospital notification to the admitting emergency room, and timely and competent in-hospital treatment at the emergency department. Stroke-trained emergency services play a key role in diagnosing the stroke symptoms and transferring the patient to the nearest available stroke unit or stroke center. The expertise of a well-trained hospital staff and postacute rehabilitation services are further prerequisites for this continuous stroke care pathway. There is also sufficient evidence that the benefits seen in stroke unit trials are replicated in routine practice, as long as these evidence-based principles of organized stroke unit care are considered in daily routine. 6 Striking discrepancies in infrastructure and quality of stroke care, but also in costs and outcome, have been identified Abstract—In the recent Helsingborg declaration, acute organized stroke unit care was described as the backbone of the chain of care for all European stroke victims. Access to stroke units is, however, still limited. To improve the availability and the quality of affordable stroke care, the European Stroke Organisation (ESO) has appointed an ESO Stroke Unit Certification Committee to define the requirements and criteria for official certification as ESO Stroke Units and ESO Stroke Centres based on scientific evidence from randomized controlled trials, clinical practice guidelines, and expert consensus. Important features of modern stroke care include the presence of a dedicated stroke unit ward, a multiprofessional team approach, a comprehensive stroke unit organization, including emergency room organization, adherence to diagnostic and therapeutic time-windows, early swallowing diagnostics and therapy, …