Hemorrhagic stroke patients treated at comprehensive stroke centers (CSC) have a much better chance of survival than those treated at primary stroke centers or general hospitals.
A new study conducted by Rutgers Robert Wood Johnson Medical School, the Cardiovascular Institute of New Jersey and the Comprehensive Stroke Center at Robert Wood Johnson University shows that comprehensive stroke centers are better equipped to deal with hemorrhagic stroke patients.
Scientists examined about 37,000 hemorrhagic stroke patients using the Myocardial Infarction Database Acquisition System (MIDAS). The study took place between 1996 and 2012, at 87 Jersey hospitals, and was meant to gather 90-day survival data from patients.
For the study, 40 per cent of the 37,000 patients were admitted to a comprehensive stroke center (a total of 13) and the other 60 per cent were admitted at either primary stroke centers (52) or non-stroke centers (22).
Research has shown that patients treated at CSCs from the start have a 7 per cent reduced risk of death at 90 days (and those with strokes due to aneurysms – subarachnoid hemorrhage – had 27 per cent reduced risk of death) than those treated at non-specialized centers.
Patients who were initially treated at other hospitals before being transferred to a CSC within 24 hours only had a 36 per cent reduced risk of death at 90 days than those who continues to be treated at non-specialized centers.
James McKinney III, MD of Rutgers-Robert Wood Johnson Medical School, gave a statement saying that “The survival benefit associated with treatment at a comprehensive stroke center was really driven by subarachnoid hemorrhage”.
He informs that patients treated at CSCs were much more likely to receive neurosurgical and endovascular treatments (18.9 per cent as opposed to 4.7 per cent). They had better chances of receiving a craniotomy or craniectomy, having their external ventricular drainage replaced if needed and neurosurgical clipping, among other things.
All of these procedures led to a lower mortality rate as 30-day, 90-day and 1-year death rates all dropped a,ong patients treated at a CSC.
These centers are simply designed to have access to neurosurgeons, neuroradiologists and other highly specialized personnel 24 hours a day, 7 days a week, and these specialists can provide better diagnostics and treatment options.
The type of center you’re admitted to may not be crucially important to all patients as intracerebral hemorrhage patients (ICH) treated in CSCs did not benefit from a much better 90-day mortality rate than those treated at other centers. Subarachnoid hemorrhage patients (SAH) however did experience a great improvement in the 90-day mortality rate – 27 per cent reduced risk of death as opposed to 40.8 per cent
Dr McKinney concludes that more patients can survive hemorrhagic strokes at CSCs. While doctors can not ignore factors like a patient’s age, his general observation is that patients admitted to CSC’s were 5 years younger, on average, than the ones admitted to other hospitals. The patients who eventually got transferred to a CSC were typically a lot younger than those who continued treatment at other hospitals.
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