SAEM Board Retires Stroke Policy Statement

ACEP News 
June 2009

By Yu-Feng Yvonne Chan, M.D., FACEP

Earlier this year, the Society for Academic Emergency Medicine (SAEM) rescinded its 6-year-old clinical policy statement about the use of thrombolytics in acute ischemic stroke, citing new evidence.

"Clinical Policy Statement on Lytic Therapy in Stroke," adopted by the SAEM Board of Directors in January 2003, was generated as a result of perceived concerns on the use of thrombolytics in acute ischemic stroke.

The 2003 policy questioned the benefit of thrombolytics in acute ischemic stroke and did not support thrombolytics as a "standard of care." The policy statement also did not endorse the concept of designated stroke centers.

Since the policy statement's publication, a number of phase IV trials have been published, adding to the body of literature supporting the benefit of thrombolytics in acute ischemic stroke when given within 3 hours.

As a result of this growing body of evidence, various organizations have revised their stroke policy statements. Most recently, the SAEM Neurological Emergencies Interest Group petitioned the Board to review its acute stroke policy statement and consider an evidence-based update.

The request was reviewed at SAEM's January 2009 meeting, where Board members voted to sunset (rescind) the standing policy statement. SAEM currently has no policy statement for or against the use of thrombolytics and/or stroke centers.

According to SAEM Immediate Past President Dr. Katherine L. Heilpern and President Dr. Jill M. Baren, the Board's stance is not to take an official position on clinical care policies.

The mission of SAEM is to advance patient care through research and education, they said, adding that the Board does not anticipate making more clinical policy statements in the future.

DR. CHAN is an assistant professor in the department of emergency medicine at the Mount Sinai School of Medicine, New York. She is the chair of SAEM's Neurological Emergencies Interest Group.

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