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. 2015 May 6;4(5):e001448.
doi: 10.1161/JAHA.114.001448.

Comprehensive stroke centers may be associated with improved survival in hemorrhagic stroke

James S McKinney  1 , Jerry Q Cheng  2 , Igor Rybinnik  3 , John B Kostis  2 ; Myocardial Infarction Data Acquisition System (MIDAS 22) Study Group
Collaborators, Affiliations

Comprehensive stroke centers may be associated with improved survival in hemorrhagic stroke

James S McKinney et al. J Am Heart Assoc. .

Abstract

Background: Comprehensive stroke centers (CSCs) provide a full spectrum of neurological and neurosurgical services to treat complex stroke patients. CSCs have been shown to improve clinical outcomes and mitigate disparities in ischemic stroke patients. It is believed that CSCs also improve outcomes in hemorrhagic stroke.

Methods and results: We used the Myocardial Infarction Data Acquisition System (MIDAS) database, which includes data on patients discharged with a primary diagnosis of intracerebral hemorrhage (ICH; International Classification of Diseases, Ninth Revision [ICD-9] 431) and subarachnoid hemorrhage (SAH; ICD-9 430) from all nonfederal acute care hospitals in New Jersey (NJ) between 1996 and 2012. Out-of-hospital deaths were assessed by matching MIDAS records with NJ death registration files. The primary outcome variable was 90-day all-cause mortality. The primary independent variable was CSC versus primary stroke center (PSC) and nonstroke center (NSC) admission. Multivariate logistic models were used to measure the effects of available covariates. Overall, 36 981 patients were admitted with a primary diagnosis of ICH or SAH during the study period, of which 40% were admitted to a CSC. Patients admitted to CSCs were more likely to have neurosurgical or endovascular interventions than those admitted to a PSC/NSC (18.9% vs. 4.7%; P<0.0001). CSC admission was associated with lower adjusted 90-day mortality (35.0% vs. 40.3%; odds ratio, 0.93; 95% confidence interval, 0.89 to 0.97) for hemorrhagic stroke. This was particularly true for those admitted with SAH.

Conclusions: Hemorrhagic stroke patients admitted to CSCs are more likely to receive neurosurgical and endovascular treatments and be alive at 90 days than patients admitted to other hospitals.

Keywords: comprehensive stroke center; intracerebral hemorrhage; subarachnoid hemorrhage.

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Figures

Figure 1
Figure 1
Temporal trends in the percentage of patients admitted to comprehensive stroke centers (CSC) versus primary stroke centers (PSC) and nonstroke centers (NSC) for patients with (A) intracerebral hemorrhage (ICH) and (B) subarachnoid hemorrhage (SAH).
Figure 2
Figure 2
Temporal trends in 90-day mortality for patients admitted to comprehensive stroke centers (CSC) versus primary stroke centers (PSC) and nonstroke centers (NSC) for patients with (A) intracerebral hemorrhage (ICH) and (B) subarachnoid hemorrhage (SAH).
Figure 3
Figure 3
Kaplan-Meyer survival curve for hemorrhagic stroke patients admitted to comprehensive stroke centers (CSC) versus primary stroke centers (PSC) and nonstroke centers (NSC). ICH indicates intracerebral hemorrhage; SAH, subarachnoid hemorrhage.
See this image and copyright information in PMC

References

    1. Kunitz SC, Gross CR, Heyman A, Kase CS, Mohr JP, Price TR, Wolf PA. The pilot stroke data bank: definition, design, and data. Stroke. 1984;15:740–746. - PubMed
    1. McKinney JS, Deng Y, Kasner SE, Kostis JB. Comprehensive stroke centers overcome the weekend versus weekday gap in stroke treatment and mortality. Stroke. 2011;42:2403–2409. - PubMed
    1. Iihara K, Nishimura K, Kada A, Nakagawara J, Ogasawara K, Ono J, Shiokawa Y, Aruga T, Miyachi S, Nagata I, Toyoda K, Matsuda S, Miyamoto Y, Suzuki A, Ishikawa KB, Kataoka H, Nakamura F, Kamitani S. Effects of comprehensive stroke care capabilities on in-hospital mortality of patients with ischemic and hemorrhagic stroke: J-aspect study. PLoS One. 2014;9:e96819. - PMC - PubMed
    1. Lichtman JH, Jones SB, Leifheit-Limson EC, Wang Y, Goldstein LB. 30-day mortality and readmission after hemorrhagic stroke among medicare beneficiaries in joint commission primary stroke center-certified and noncertified hospitals. Stroke. 2011;42:3387–3391. - PMC - PubMed
    1. Alberts MJ, Latchaw RE, Selman WR, Shephard T, Hadley MN, Brass LM, Koroshetz W, Marler JR, Booss J, Zorowitz RD, Croft JB, Magnis E, Mulligan D, Jagoda A, O'Connor R, Cawley CM, Connors JJ, Rose-DeRenzy JA, Emr M, Warren M, Walker MD. Recommendations for comprehensive stroke centers: a consensus statement from the brain attack coalition. Stroke. 2005;36:1597–1616. - PubMed

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