Haemorrhagic stroke proportion reassessment at the emergency department gives the first green light – a necessary follow-up in Romania


Correspondence: Adrian Stănescu, UPU-SMURD Tîrgu-Mureş, Str. Gheorghe Marinescu nr. 50, Tîrgu-Mureș, jud. Mureș, 540136, România.

E-mail: adrian.stanescu@fundatiapentrusmurd.ro, adrianstanescu85@gmail.com

Dear Editor

We reassessed the previously reported proportion of haemorrhagic strokes presented in the emergency department (ED) of the Tîrgu-Mureș County Emergency Hospital in Romania, the largest hospital in the country. Six years ago, it hosted two studies [1] aiming to determine an overview, which pointed out a very elevated 26·8% intracerebral haemorrhage ratio for the retrospective study and a 21·6% ratio for the prospective one. It was admitted at the time that there are important biases to take under consideration.

Until the beginning of 2011, EDs throughout the country were not the only ones to attend acute onset conditions. A very large number of patients would also address ‘ambulatory services’, which were buffer-like structures for each hospital specialty, prone to handle less severe cases. Tîrgu-Mureș County Emergency Hospital was the first one to disband these services, leaving only the ED to handle all acute onset cases. Later on mid-2012, this practice spread to a lot more hospitals. Also, a new national health services law had taken effect with significant implications as to the organization of EDs and prehospital care.

It is because of these reasons why a new retrospective study was conducted at the same ED using the same protocol. All 1135 stroke patients were enlisted, spanning over eight months.

The end result was a sudden drop of the haemorrhagic stroke ratio from the previously claimed 21–27% to 13·3%, inside a ‘green light’ interval generally suited for the Western countries. The current study shows what a dramatic effect over the evaluation of stroke sub-types does a medical organization system have and further invites to a nationwide follow-up in the years to come.