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Stroke survival best in specialist units

Ischaemic stroke patients more likely to survive in specialist units

Louise Prime

Wednesday, 26 January 2011

People admitted to designated specialist units after an ischaemic stroke were more likely to survive than people admitted to other units, as well as more likely to receive thrombolysis, according to a US study published today in JAMA.

About one in seven acute care hospitals in the US are designated as ‘primary stroke centres’ – they have been certified by the Joint Commission, according to criteria that the Brain Attack Coalition developed to improve acute stroke care. But this research is the first to produce good evidence regarding their effectiveness in reducing mortality.

Researchers analysed mortality data on 30,947 patients admitted with acute ischaemic stroke to either designated stroke centres (49.4% of patients) or non-designated hospitals (50.6% of patients), in New York State in 2005-06.

So they could be sure that any differences that emerged were specific to stroke, the researchers also looked at death rates among patients admitted to designated and non-designated hospitals for gastrointestinal haemorrhage or myocardial infarction.

All-cause mortality at 30 days was 10.1% for patients admitted to designated stroke centres and 12.5% for patients in non-designated hospitals. Thrombolytic therapy was used for 4.8% of patients in designated stroke centres and in 1.7% of patients in non-designated hospitals.

The authors found that: “Differences in mortality also were observed at 1-day, 7-day, and 1-year follow-up. The outcome differences were specific for stroke, as stroke centres and non-designated hospitals had similar 30-day all-cause mortality rates among those with gastrointestinal haemorrhage or acute myocardial infarction.

“Even though the differences in outcomes between stroke centres and non-designated hospitals were modest, our study suggests that the implementation and establishment of a BAC-recommended stroke system of care was associated with improvement in some outcomes for patients with acute ischaemic stroke.”

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