STROKE CENTER DESIGNATIONS

Not all strokes are the same

Similar to how patients are treated in the trauma model, designating stroke centers as Level 1, 2, and 3 — depending on physician experience, training, and caseload — will help EMS match patient needs to patient care.

The designations, which were developed by 13 international medical societies based on expert opinions and the most current evidence from stroke care around the world, describe the minimum organization and workload that a hospital should have to practice acute ischemic stroke interventions such as thrombectomy. They also provide recommendations for patient transport between hospitals.

These guidelines, however, are not a substitute for existing national and regional guidelines.

“ELVO patients should be taken to Level 1 stroke centers. Establishing guidelines for Level 2 stroke centers gives patients a chance at the best possible outcome in underserved regions. These guidelines, issued by this eminent group of organizations, will help facilities around the world maintain the highest standard of care for stroke patients.”

Designations at a Glance

Level 1Level 2Level 3
CapabilityFull spectrum careThrombectomy-capableSome capacity
# of patients/year25010050
# of procedures/year5050N/A
Dedicated neuro-ICU unitYesSometimesNo
Dedicated stroke unitYesYesYes
Neurosurgical services onsiteYesSometimes but may transferSometimes but may transfer

Level 1 Stroke Centers

Ideally, all severe stroke patients would be treated at a Level 1 stroke center, which offers a full spectrum of neuroendovascular care. Hospitals that provide a similar level of care are also known as comprehensive stroke centers.

If there is no Level 1 stroke center available within two hours of the patient’s location, patients can be taken to a Level 2 stroke center.

Level 2 Stroke Centers

Level 2 stroke centers are appropriate for patients when a Level 1 stroke center is more than two hours away from the patient’s location.

A Level 2 stroke center may transfer some cases to a Level 1 center. A Level 2 stroke center will occasionally receive transfers from a Level 3 stroke center if there is not a Level 1 stroke center within two hours of the patient’s location.

Level 3 Stroke Centers

Level 3 stroke centers are appropriate for a patient when a Level 1 or 2 stroke center is more than two hours away from the patient’s location.

Level 2 centers should help Level 3 centers identify suspected or confirmed ELVO patients and facilitate rapid transfer as part of a “hub and spoke” model of care. However, if a patient can be taken to a Level 1 center in a similar amount of time as it would take to reach the Level 3 center, it is preferable that the patient is directed to a Level 1 facility.

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Level 3 Stroke Center Graphic

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Get Ahead of Stroke® is a national public education and advocacy campaign designed to improve systems of care for stroke patients. Founded in 2016 by the Society of NeuroInterventional Surgery (SNIS), today the campaign is supported by a coalition of organizations with the goal of securing the best possible outcomes for stroke patients by driving policy change and public awareness nationwide.

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