Tuesday, May 19, 2015

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

The key word here is MAY, they never give useable statistics that you can use to rate hospitals to see if they are any good. Why 90 days when 30 days is the standard reporting timeframe? This is so simple to prove, you take MRIs at admission and then at the 30 or 90 day mark and compare dead areas. That would be objective although I guess death is objective also.
http://www.docguide.com/comprehensive-stroke-centers-may-be-associated-improved-survival-hemorrhagic-stroke?

Data Acquisition System (MIDAS 22) Study Group ; Journal of the American Heart Association 4 (5), (2015)

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.


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