Comprehensive Stroke Centers had higher risk-adjusted in-hospital mortality for emergency department admissions compared to Primary Stroke Centers (4.6% vs 3.8%; OR 1.14; 95% CI 1.01-1.29).
Observational (n=722,941)
Yes
Does care at Comprehensive Stroke Centers compared to Primary Stroke Centers improve in-hospital outcomes in patients with acute ischemic stroke?
While Comprehensive Stroke Centers provide faster and more frequent acute reperfusion therapy than Primary Stroke Centers, they are associated with slightly higher risk-adjusted in-hospital mortality, highlighting the need for targeted quality improvement.
Effect estimate: OR 1.14 (95% CI 1.01-1.29)
Absolute Event Rate: 4.6% vs 3.8%
BACKGROUND: To improve stroke care, the Brain Attack Coalition recommended establishing primary stroke center (PSC) and comprehensive stroke center (CSC) certification. This study aimed to compare ischemic stroke care and in-hospital outcomes between CSCs and PSCs. METHODS AND RESULTS: We analyzed patients with acute ischemic stroke who were hospitalized at stroke centers participating in Get With The Guidelines-Stroke from 2013 to 2015. Multivariable logistic regression models were generated to examine the association between stroke center certification (CSC versus PSC) and performances and outcomes. This study included 722 941 patients who were admitted to 134 CSCs and 1047 PSCs. Both CSCs and PSCs had good conformity to 7 performance measures and the summary defect-free care measure. Among emergency department admissions, CSCs had higher intravenous tPA (tissue-type plasminogen activator) and endovascular thrombectomy rates than PSCs (14.3% versus 10.3%, 4.1% versus 1.0%, respectively). Door to intravenous tPA time was shorter at CSCs (median, 52 versus 61 minutes; adjusted risk ratio, 0.92; 95% confidence interval, 0.89-0.95). More patients at CSCs had door to intravenous tPA time ≤60 minutes (79.7% versus 65.1%; adjusted odds ratio, 1.48; 95% confidence interval, 1.25-1.75). For transferred patients, CSCs and PSCs had comparable overall performance in defect-free care, except higher endovascular thrombectomy therapy rates. The overall in-hospital mortality was higher at CSCs in both emergency department admissions (4.6% versus 3.8%; adjusted odds ratio, 1.14; 95% confidence interval, 1.01-1.29) and transferred patients (7.7% versus 6.8%; adjusted odds ratio, 1.17; 95% confidence interval, 1.05-1.32). In-hospital outcomes were comparable between CSCs and PSCs in patients who received intravenous tPA or endovascular thrombectomy. CONCLUSIONS: CSCs and PSCs achieved similar overall care quality for patients with acute ischemic stroke. CSCs exceeded PSCs in timely acute reperfusion therapy for emergency department admissions, whereas PSCs had lower risk-adjusted in-hospital mortality. This information may be important for acute stroke triage and targeted quality improvement.
Man et al. (Wed,) conducted a observational in Acute ischemic stroke (n=722,941). Comprehensive Stroke Centers (CSCs) vs. Primary Stroke Centers (PSCs) was evaluated on In-hospital mortality for emergency department admissions (OR 1.14, 95% CI 1.01-1.29). Comprehensive Stroke Centers had higher risk-adjusted in-hospital mortality for emergency department admissions compared to Primary Stroke Centers (4.6% vs 3.8%; OR 1.14; 95% CI 1.01-1.29).