Influence of Hospital Type on Outcomes of Patients With Acute Spontaneous Intracerebral Hemorrhage
Joan Martí‐Fábregas, Anna Ramos‐Pachón, Luís Prats‐Sánchez, Ana Núñez-Guillén, Blanca Lara Rodríguez, David Rodríguez‐Luna, Sergio Amaro, Yolanda Silva, Ana Rodríguez-Campello, Isabel Puig, Manuel Gómez‐Choco, Daniel Vázquez-Justes, Nicolau Guanyabens, Dolores Cocho, David Cánovas, Eva Giralt‐Steinhauer, Laura Llull, Marina Guasch‐Jiménez, Alejandro Martínez‐Domeño, Rebeca Marín, Álvaro Lambea‐Gil, Garbiñe Ezcurra‐Díaz, Andrés Paipa-Merchan, Helena Quesada, M Casadevall, Denisse Wenger, Olalla Pancorbo, Laia Seró, Jordi Pérez, Xavier Costa, José Zaragoza, Noelia Rodríguez‐Villatoro, Esther Catena, Núria Matos Calvo, Jerzy Krupiński, Natàlia Pérez de la Ossa, Sònia Abilleira, Mercè Salvat-Plana, Olga Fagundez, Pol Camps‐Renom, for HIC-CAT
Abstract
BACKGROUND AND OBJECTIVES: Whether the outcome of patients with spontaneous intracerebral hemorrhage (ICH) differs depending on the type of hospital where they are admitted is uncertain. The objective of this study was to determine influence of hospital type at admission (telestroke center [TSC], primary stroke center [PSC], or comprehensive stroke center [CSC]) on outcome for patients with ICH. We hypothesized that outcomes may be better for patients admitted to a CSC. METHODS: This is a multicenter prospective observational and population-based study of a cohort of consecutively recruited patients with ICH (March 2020-March 2022). We included all patients with spontaneous ICH in Catalonia (Spain) who had a pre-ICH modified Rankin scale (mRS) score of 0-3 and who were admitted to the hospital within 24 hours of onset. We compared patients admitted to a TSC/PSC (n = 641) or a CSC (n = 1,320) and also analyzed the subgroup of patients transferred (n = 331) or not transferred (n = 310) from a TSC/PSC to a CSC. The main outcome was the 3-month mRS score obtained by blinded investigators. Outcomes were compared using adjusted ordinal logistic regression to estimate the common odds ratio (OR) and 95% CI for a shift in mRS scores. A propensity score matching (PSM) analysis was performed for the subgroup of transferred patients. RESULTS: = 0.16). DISCUSSION: In this population-based study, we found that, after adjusting for confounders, hospital types were not associated with functional outcomes. In addition, for patients who were transferred from a TSC/PSC to a CSC, PSM indicated that outcomes were similar to nontransferred patients. Our findings suggest that patient characteristics are more important than hospital characteristics in determining outcome after ICH. TRIAL REGISTRATION INFORMATION: ClinicalTrials.gov Identifier: NCT03956485.