Background: Although targeted towards ischemic stroke patients, the benefit of primary stroke centers (PSCs) certification by Joint Commission (JC) may extends to patients with subarachnoid hemorrhage. We compared the rates of in-hospital procedures, adverse events and discharge outcomes among subarachnoid hemorrhage patients between PSCs and non PSCs hospitals in United States.
Methods: We analyzed the data from Nationwide Inpatient Sample from 2010 and 2011. The analysis was limited to States that publicly reported hospital identity and included patients (age ≥18 years) discharged with a principal diagnosis of subarachnoid hemorrhage (ICD9 codes 430). PSCs were identified by matching the NIS hospital files with the list provided by JC.
Results: A total of 4,350 subarachnoid hemorrhage patients were analyzed of which 3,098 (71.1%) patients were admitted at PSCs. After adjusting for DRG-based disease severity, and hospital characteristics, patients admitted at PSCs had higher rate of in-hospital procedures; endovascular treatment (odds ratio [OR], 2.9; 95% confidence interval [CI], 2.1 to 3.9), intracranial angioplasty (OR, 1.6; 95% CI, 1.4 - 1.8), and ventriculostomy (OR, 1.5; 95% CI, 1.3 to 1.9). There was no difference for procedures such as surgical treatment (OR, 1.2; 95% CI, 0.9 - 1.5), mechanical ventilation (OR, 1.1; 95% CI, 0.9 - 1.3) or ventriculo-peritoneal shunt (OR, 0.8; 95% CI, 0.6 to 1.4). In-hospital adverse events were similar between two groups. After adjusting for age, co-morbidities, DRG-based disease severity, and hospital characteristics, patients admitted at PSCs were more likely to more likely to be discharged to home (OR, 1.4; 95% CI, 1.2- 1.7) .
Conclusions: Compared with non PSCs admissions, patients with subarachnoid hemorrhage admitted to PSCs are more likely to receive endovascular treatment and had higher odds of being discharged to home. Such observations support the notion that PSC certification may favorably impact outcomes in all stroke subtypes.