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Primary Versus Comprehensive Stroke Centers: What’s the Difference?

Efforts in Georgia aim to improve stroke care.

Similar to the systems in place to direct patients to appropriate-level trauma centers based on the nature of their injuries, vital signs and consciousness, stroke patients require different intensities of treatment depending on the type and severity of their condition and other complications.

What’s the difference?

Primary stroke centers – certified by the Joint Commission, a non-profit organization that accredits hospitals – are equipped to provide emergent care, including clot-busting therapy, and more extensive evaluation and care than the average stroke-ready hospital does to help stabilize a patient. But some patients may need more advanced interventional techniques, which many primary stroke centers do not offer. Primary stroke centers will refer patients who require more advanced care to a comprehensive stroke center. These centers have cutting-edge neurosurgical interventions and treat other types of stroke beyond those caused by a blockage in a blood vessel (ischemic stroke) – for example, cerebral hemorrhage caused by an artery breaking inside the brain. They also have specialized neurological intensive care units.  

“There are 750,000 strokes annually in the United States, and less than 10 percent receive an acute interventional therapy due to time constraints and operational capabilities of stroke centers unable to provide interventional procedures,” explains Rishi Gupta, M.D., MBA, director of neurocritical care at Wellstar Health Systems’ Kennestone Hospital in Marietta, Ga.

Although early treatment helps address and guard against stroke-related deficits, care must be performed in concert with a cutting-edge rehabilitation hospital, as well, Dr. Gupta notes. “There must be a collaborative model of early mobilization and rehabilitation to offer the patient the best opportunity for improvement,” he adds.

Advancing Stroke Care in Georgia, Specifically

In Georgia, efforts are increasing to improve stroke prevention and treatment.

“We are in the stroke belt,” says Mitch Fillhaber, senior vice president of managed care at Shepherd Center, an Atlanta-based rehabilitation hospital for people with spinal cord and brain injury, including stroke. “And the growing number of younger stroke patients is especially concerning. These are people who need to resume their careers, go back to school, raise families and be active.”

Shepherd Center is building on its age-related experience in rehabilitation care for traumatic brain and spinal cord injury and extending it to stroke, Fillhaber notes. The hospital is also part of a team of facilities across the state that is collaborating to advance acute and post-acute stroke care.

According to the Joint Commission, there are 18 stroke centers in Georgia.

For more information about stroke rehabilitation care at Shepherd Center, visit

Written by Amanda Crowe, MA, MPH
Photos by Louie Favorite

About Shepherd Center

Shepherd Center provides world-class clinical care, research, and family support for people experiencing the most complex conditions, including spinal cord and brain injuries, multi-trauma, traumatic amputations, stroke, multiple sclerosis, and pain. An elite center recognized as both Spinal Cord Injury and Traumatic Brain Injury Model Systems, Shepherd Center is ranked by U.S. News as one of the nation’s top hospitals for rehabilitation. Shepherd Center treats thousands of patients annually with unmatched expertise and unwavering compassion to help them begin again.