Abstract T P167: The Relationship Between Stroke Center and Transfer Time on Mortality of Subarachnoid Hemorrhage: An Instrumental Variable Analysis
Objective: Recommendations for comprehensive stroke centers (CSC) have been launched, but evaluations of these with respect to accessibility and mortality have not been clear. We thus examined the relationship between stroke centers and transfer time on mortality of subarachnoid hemorrhage (SAH) from a nationwide survey: J-ASPECT Study in Japan.
Methods: We approached 1,369 certified training institutions in Japan with a survey regarding acute stroke care capabilities, and 749 hospitals responded. The CSC score was generated to evaluate the capabilities of CSC (Iihara K et al. PLOS One 2014). Data for patients hospitalized with stroke were gathered from the Japanese Diagnosis Procedure Combination database from April 1, 2010 to May 31, 2012. Transfer time was measured using an electronic mapping system based on patients’ postal addresses and hospitals. We examined the effects of CSC scores on mortality using instrumental variable analysis with log-transferred transfer time as an instrumental variable, adjusted by age, gender, and scores of the Japan coma scale (JCS) which was grading with the 1-, 2-, and 3-digit codes (Iihara K et al. PLOS One 2014).
Results: Data from 265 institutions and 9,648 emergency-hospitalized patients with SAH were analyzed. Mortality rate was 28.8% and median transfer time was 22 min. Longer transfer times were associated with high CSC scores (p < 0.001). Adjusting for log-transformed transfer time, high CSC scores corresponded to lower mortality in patients with SAH, and the adjusted difference between high and low scores was 25.6% (95%CI= 8.5 - 42.6%). The severe SAH patients with JCS of 2- or 3-digit code showed more influence of CSC score on mortality, and the difference was 33.5% (95%CI= 21.5 - 45.5%).
Conclusion: Longer transfer times were associated with the choice of highly qualified stroke centers measured by CSC scores, and highly qualified stroke centers were associated with lower mortality of SAH.
Author Disclosures: A. Kada: None. K. Nishimura: None. S. Kamitani: None. A. Nishimura: None. R. Kurogi: None. T. Sayama: None. K. Iihara: None.
- © 2015 by American Heart Association, Inc.