Abstract T P290: Improvement in ICH Outcomes Not Detected During Emergence of a Comprehensive Stroke Center

Abstract

Background: Our previous research has demonstrated improved acute ischemic stroke (AIS) care and outcomes as the program evolved to primary stroke center (PSC) and then comprehensive stroke center (CSC) certification from The Joint Commission. We explored the impact of program accreditation on patients with intra-cerebral hemorrhage (ICH) who presented directly to our center. Methods: Patients admitted to Tulane University Medical Center (TUMC) from 07/2008-10/2013 for ICH were retrospectively assessed. Transfers were excluded. Patient outcomes were compared according to patient admission date: admitted while our center was an emerging PSC (ePSC, 07/08-03/10) or an emerging CSC (eCSC, 04/10-10/13). Results: Out of the 273 patients with ICH during the study period, 12 (16.22%) and 29 (14.57%) transferred patients were excluded from ePSC and eCSC groups, respectively. ePSC and eCSC patients did not differ significantly in age, race, gender, baseline NIHSS, baseline ICH severity, or time to hospitalization. Short-term outcomes including poor functional outcome (modified Rankin scale 3-6), favorable discharge disposition (home or rehab facility), and in-hospital mortality did not differ. eCSC patients had a reduced incidence of nosocomial pneumonia (10.71% vs. 20.97%, p=0.043). eCSC patients received more CT angiograms (72.19% vs. 51.61%, p=0.003) with a notable decrease in spot signs (10.26% vs. 25.00%, p=0.030). Rates of any neurosurgical intervention did not significantly change. Conclusion: Short-term outcomes for ICH patients did not significantly change as our center evolved into a certified CSC. While we were more aggressive with acute neuroimaging, we detected fewer patients with active bleeding, and the rate of neurosurgical intervention did not change. Overall, progression from PSC to CSC certification was associated with potential over-utilization of resources and no detected improvement in early outcomes for ICH, despite lower incidence of pneumonia. Additional research is needed to assess whether this pattern holds true at other centers.