Are patients with intracerebral haemorrhage disadvantaged in hospitals?

Authors

  • Renee Sheedy,

    1. Barwon Health, Geelong, VIC, Australia
    2. La Trobe University, Melbourne, VIC, Australia
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  • Julie Bernhardt,

    1. La Trobe University, Melbourne, VIC, Australia
    2. The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
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  • Christopher R. Levi,

    1. Center for Brain and Mental Health Research, Hunter Medical Research Institute, Hunter New England Area Health, Newcastle University, Newcastle, NSW, Australia
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  • Mark Longworth,

    1. Statewide Stroke Services, NSW Agency for Clinical Innovation, Sydney, NSW, Australia
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  • Leonid Churilov,

    1. The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
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  • Monique F. Kilkenny,

    1. The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
    2. Translational Public Health Unit, Stroke & Ageing Research, Southern Clinical School, Monash University, Melbourne, VIC, Australia
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  • Dominique A. Cadilhac,

    Corresponding author
    1. The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
    2. Translational Public Health Unit, Stroke & Ageing Research, Southern Clinical School, Monash University, Melbourne, VIC, Australia
    • Correspondence: Dominique A. Cadilhac, Stroke and Ageing Research Centre (STARC), Department of Medicine, Southern Clinical School, Monash University, Level 1/42-51 Kanooka Grove, Clayton, Melbourne, VIC 3168, Australia.

      E-mail: dominique.cadilhac@monash.edu

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  • and on behalf of the New South Wales Stroke Services Coordinating Committee and the Agency for Clinical Innovation


  • Conflict of interest: None declared.

Abstract

Background and Aims

Providing evidence-based clinical care reduces disability and mortality rates following stroke. We examined if compliance with evidence-based processes of care were different for patients with intracerebral haemorrhage when compared with ischemic stroke and sought to describe differences in health outcomes during hospitalization and at time of discharge for these stroke subtypes.

Methods

The New South Wales acute stroke dataset was used. This included data from 50–100 consecutively admitted patients’ medical records collected from 32 New South Wales hospitals between 2003 and 2010. Multivariable logistic regression analyses were conducted taking into account patient factors and clustering of patients by hospital.

Results

Ischemic stroke and intracerebral haemorrhage cases had similar demographic features (ischemic stroke n = 3467, mean age 74 years [standard deviation 13], 50% female; intracerebral haemorrhage n = 275, mean age 74 years [standard deviation 13], 48% female). Following multivariable analyses patients with intracerebral haemorrhage were less likely to be admitted to a stroke unit (adjusted odds ratio 0·65; 95% confidence interval 0·45–0·94) or receive an assessment from allied health (adjusted odds ratio 0·54; 95% confidence interval 0·33–0·89) than patients with ischemic stroke. Patients with intracerebral haemorrhage are also less likely to be independent (adjusted odds ratio 0·36; 95% confidence interval 0·3–0·5) at time of hospital discharge and had a greater odds of dying in hospital (adjusted odds ratio 2·1; 95% confidence interval 1·3–3·5). Patients that were admitted to a stroke unit had a greater odds of being independent (modified Rankin Score 0–2) at day 7–10 irrespective of stroke type or severity on admission (adjusted odds ratio 1·3; 95% confidence interval 1·01–1·66).

Conclusions

Following intracerebral haemorrhage, patients were less likely to be admitted to an acute stroke unit and receive allied health interventions. Admission to stroke units improved the likelihood of being independent at days 7–10 and, therefore, more should be done to encourage evidence-based care for intracerebral haemorrhage.

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