Introduction: There is minimal real-world data on whether stroke process quality metrics differ for intracerebral hemorrhage (ICH) and acute ischemic stroke (AIS) and if they have changed over time. Identifying and addressing these differences may inform targeted quality improvement initiatives to optimize acute stroke outcomes. Methods: AIS and ICH patients admitted to Get With The Guidelines-Stroke participating hospitals from Jan 1, 2015 to June 30, 2024 who arrived by emergency medical services (EMS) were included. Outcomes included prehospital-based process metrics (EMS prenotification, last known well (LKW) and stroke symptom onset to ED arrival time) and ED-based metrics (door to ED physician assessment; door to stroke team activation; door to stroke team arrival; door to first stroke severity score; door to initial brain imaging order; and door to initial brain imaging report). Generalized estimating equations were used in logistic and linear regression models to evaluate the association between stroke type (ICH vs AIS) and outcomes, with sequential adjustment for patient demographics, medical history and presenting factors, and hospital characteristics. Temporal trends of prehospital care metrics were examined. Results: 195,659 patients (N=31,464 with ICH; N=164,195 with AIS) from 195 hospitals were included. The median (IQR) NIHSS was 14 (6-23) for ICH vs 6 (2-13) for AIS (absolute standardized difference 69.4). ICH (vs AIS) was associated with higher odds of door to ED physician assessment ≤10 mins after adjusting for patient demographics (aOR 1.08, 95% CI 1.02, 1.14). This association reversed after adding adjustment for medical history and presenting factors (including NIHSS), and hospital characteristics (aOR 0.94, 95% CI 0.89, 0.99). A similar pattern was observed for door to initial brain imaging order ≤20 mins (demographic-adjusted: aOR 1.09, 95% CI 1.02, 1.16; fully adjusted with medical history and hospital characteristics: aOR 0.91, 95% CI 0.85, 0.97). Median LKW to arrival time increased by 32.5% for AIS (151 to 200 min; p < .0001) and 34.3% (108 min to 145 min; p < .0001) for ICH over the study period. Discussion: From 2015 to 2024, patients with ICH were less likely to achieve timely ED-based process metrics compared to patients with AIS, despite faster presentation to the ED. Future quality improvement initiatives should target these differences to ensure all patients with stroke receive time-sensitive care.
Royan et al. (Thu,) studied this question.