title: Comprehensive stroke centers may be associated with improved survival in hemorrhagic stroke.
abstract: 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.
  
  
  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.
authors.affiliation: Department of Neurology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ (J.S.M.K., I.R.) The Cardiovascular Institute of New Jersey, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ (J.S.M.K., J.Q.C., J.B.K.).
authors.forename: James S
authors.initials: JS
authors.lastname: McKinney
authors.affiliation: The Cardiovascular Institute of New Jersey, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ (J.S.M.K., J.Q.C., J.B.K.).
authors.forename: Jerry Q
authors.initials: JQ
authors.lastname: Cheng
authors.affiliation: Department of Neurology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ (J.S.M.K., I.R.).
authors.forename: Igor
authors.initials: I
authors.lastname: Rybinnik
authors.affiliation: The Cardiovascular Institute of New Jersey, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ (J.S.M.K., J.Q.C., J.B.K.).
authors.forename: John B
authors.initials: JB
authors.lastname: Kostis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization; D006801:Humans; D020300:Intracranial Hemorrhages / Q000401:mortality* / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009515:New Jersey; D010351:Patient Discharge / Q000706:statistics & numerical data; D012189:Retrospective Studies; D020521:Stroke / Q000401:mortality* / Q000628:therapy; D016019:Survival Analysis
keywords: comprehensive stroke center; intracerebral hemorrhage; subarachnoid hemorrhage