More on acute stroke care

In two recent posts,[1] [2] we have drawn attention to the implications for the service of recent findings on the startling effectiveness of thrombectomy in selected ischaemic strokes. We have called for a modelling exercise to identify the ideal configurations. Relevant information to inform such models comes from two recent papers on the centralisation of acute stroke services in two metropolitan areas – Greater London and Manchester. Using a difference in difference approach (before and after, and interventions versus control sites) shows that mortality (at least in London) and length of stay (both centres) are reduced.[3] A cause and effect association is supported by process measures taken from the intervention areas and one control area.[4]

— Richard Lilford, CLAHRC WM Director


  1. Lilford R. Provocative Idea for Thrombectomy Services in Acute Stroke. NIHR CLAHRC West Midlands News Blog. 14 August 2015.
  2. Lilford R. First the Heart, Now the Brain. NIHR CLAHRC West Midlands News Blog. 10 April 2015.
  3. Morris S, Hunter RM, Ramsay AIG, et al. Impact of centralising acute stroke services in English metropolitan areas on mortality and length of hospital stay: difference-in-difference analysis. BMJ. 2014;349:g4757.
  4. Ramsay A, Morris S, Hoffman A, et al. Effects of centralizing acute stroke services on stroke care provision in two large metropolitan areas in England. Stroke. 2015;46(8);2244-50.

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