Abstract W P314: Comprehensive Stroke Centers Improve Survival in Hemorrhagic Stroke
Introduction: Comprehensive stroke centers (CSCs) have been shown to improve clinical outcomes and mitigate disparities in treatment of ischemic stroke patients. CSCs likely also improve outcomes in stroke patients with hemorrhagic stroke.
Methods: We used the Myocardial Infarction Data Acquisition System (MIDAS) database, which includes demographic and clinical data on patients discharged with a primary diagnosis of intracerebral hemorrhage (ICD-9 431) and subarachnoid hemorrhage (ICD-9 430) from all non-federal acute care hospitals in New Jersey between 1996 and 2011. Out-of-hospital deaths were assessed by matching MIDAS records with New Jersey death registration files. The primary outcome variable was all-cause mortality within 90 days of hospital admission. The primary independent variable was CSC versus primary stroke center (PSC) and non-stroke center (NSC) admission. Covariates included patient demographics, comorbid conditions, and neurosurgical treatment. Multivariate logistic and Cox regression models were used to measure the effect of available covariables.
Results: 39,134 patients were admitted with a hemorrhagic stroke during the study period. Baseline variables are presented in the Table. Neurosurgical intervention rates were low overall, but patients admitted to CSCs were more likely to have a craniotomy/craniectomy (OR 2.09, CI 1.79-2.44), ventricular drain or intracranial pressure monitor (OR 8.97, CI 7.39-10.88), surgical clipping/repair/occlusion of an aneurysm/vessel (OR 3.66, CI 3.31-4.04), or endovascular repair/occlusion of an aneurysm/vessel (OR 22.30, CI 16.28-30.53). CSC admission reduced adjusted 90-day mortality (HR 0.96, CI 0.93-0.99).
Conclusions: Hemorrhagic stroke patients admitted to CSCs are more likely to receive neurosurgical and endovascular treatments and be alive at 90 days.
Author Disclosures: J.S. McKinney: None. J. Cheng: None. I. Rybinnik: None. U. Paolucci: None. J.B. Kostis: None.
- © 2014 by American Heart Association, Inc.