Patients With Bleeding Strokes May Do Better at Specialized Centers

Study found victims were less likely to die within 90 days when treated at more advanced facilities

By Randy Dotinga

Wednesday, May 6, 2015

WEDNESDAY, May 6, 2015 (HealthDay News) -- New research finds that patients with hemorrhagic strokes, which cause bleeding in the brain, are more likely to survive if they seek treatment at a comprehensive stroke center.

"Clinicians, especially emergency room physicians, need to be aware of the severity and potential implications of hemorrhagic stroke, and try to transfer patients to the hospital most capable of providing the full complement of care," said study author Dr. James McKinney in a news release from the American Heart Association. He is an assistant professor of neurology at the Rutgers-Robert Wood Johnson Medical School in New Brunswick, N.J.

About 13 percent of strokes are hemorrhagic. They occur when a blood vessel ruptures and bleeds into the brain. Unlike other strokes that happen when a blood vessel is blocked, this kind of stroke requires treatment that stops the bleeding.

At issue is the value of treatment in comprehensive stroke centers, which have more expertise in treating stroke. Patients can get neurosurgery at these centers 24 hours a day, the study authors said.

The researchers examined survival data on almost 37,000 patients with hemorrhagic strokes who were treated from 1996 to 2012 at 87 New Jersey hospitals. Of those, 40 percent were treated at comprehensive stroke centers.

After adjusting statistics so they wouldn't be thrown off by high or low numbers of patients who share certain factors like age, the researchers found that those treated at the centers had a 7 percent lower risk of dying within 90 days. The risk was 27 percent lower in patients with a subarachnoid hemorrhage, which is bleeding on the surface of the brain when an aneurysm ruptures.

There was no difference in risk of death in patients with intracerebral hemorrhage, which occurs when tiny arteries rupture in the brain.

The researchers also found that patients were 36 percent less likely to die if they are transferred from a non-stroke center to a stroke center within 24 hours, compared to those who weren't transferred.

"The most severe patients may have been more likely to be taken to a comprehensive stroke center initially, or conversely, sicker patients at other hospitals may have been less likely to be transferred if they were already in a coma and unlikely to survive," McKinney said.

The study was published May 6 in the Journal of the American Heart Association.

SOURCE: American Heart Association, news release, May 6, 2015

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