Health News for Senior Citizens
Health News for Seniors
People with a bleeding stroke have best chance in comprehensive stroke center
By Tucker Sutherland, editor & publisher
Stroke centers have equipment, personnel to deal with most severe strokes, including neurological critical
May 6, 2015 — People with hemorrhagic strokes (brain bleeds) are more likely to survive if they are treated at a comprehensive stroke center. If not in a stroke center, their loved ones should move them, says research leader.
That is just a fact that was proven again by research published in the Journal of the American Heart Association.
Hemorrhagic strokes, which account for about 13 percent of all strokes, are caused when a weakened blood vessel in the brain ruptures and bleeds in the surrounding brain.
Comprehensive stroke centers typically have the specialists and trained personnel to deal with patients with these ruptures or other types of bleeding in the brain. They also can provide neurological intensive care and 24-hour access to neurosurgery. The American Heart Association, in conjunction with the Joint Commission, accredits Comprehensive Stroke Centers that meet standards to treat the most complex stroke cases.
“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,” says James S. McKinney, M.D., lead author and assistant professor of neurology at the Rutgers-Robert Wood Johnson Medical School in New Brunswick, New Jersey.
“When a person is diagnosed with a hemorrhagic stroke, loved-ones should ask about the possibility of a transfer,” he added.
Researchers examined the 90-day survival of 36,981 patients with hemorrhagic strokes treated at 87 hospitals in New Jersey between 1996 and 2012.
Forty percent of the patients were treated at facilities designated as comprehensive stroke centers by 2012. The remainder were treated at non-stroke centers or at hospitals designated as primary stroke centers – facilities prepared to quickly identify ischemic strokes caused by blood clots (blocking the blood vessel to the brain). They deliver clot-dissolving medication, but which may not be prepared for higher level acute neurosurgical emergencies. Mortality rates included deaths from all causes and were adjusted for factors such as age.
Compared to primary care centers or non-stroke centers, the researchers found that treatment at comprehensive stroke centers was associated with:
● 7 percent reduced risk of death for patients with all hemorrhagic strokes;
● 27 percent reduced risk of death in patients with subarachnoid hemorrhage, bleeding onto the surface of the brain after rupture of a weakened or ballooning-out vessel (aneurysm);
● 0 (no) difference in risk of death for patients with intracerebral hemorrhage, a rupture of tiny arteries within brain tissue.
Many patients with hemorrhagic strokes are diagnosed at a primary care centers or non-stroke centers and then transferred to a comprehensive stroke center for more comprehensive care.
This practice showed a survival advantage in the New Jersey study. Patients transferred within 24 hours were 36 percent less likely to die within 90 days than those who remained in a primary care center or non-stroke center.
“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 is limited by looking back at years prior to the comprehensive stroke center designation and by the lack of information on the severity of stroke or the neurological condition of the patients.
Co-authors are Jerry Q. Cheng, Ph.D.; Igor Rybinnik, M.D.; and John B. Kostis, M.D. Author disclosures are on the manuscript.
The Robert Wood Johnson Foundation funded the study.
Source: American Heart Association Rapid Access Journal Report
About Hemorrhagic Stroke
Hemorrhagic stroke occurs when a weakened blood vessel ruptures. Two types of weakened blood vessels usually cause hemorrhagic stroke: aneurysms and arteriovenous malformations (AVMs). View a detailed animation of hemorrhagic stroke.
● Learn more about strokes.
About Comprehensive Stroke Centers
Comprehensive Stroke Center Certification recognizes hospitals that meet standards to treat the most complex stroke cases. Eligibility standards include all components of a Primary Stroke Center plus:
● availability of advanced imaging techniques, including MRI/MRA, CTA, DSA and TCD
● availability of personnel trained in vascular neurology, neurosurgery and endovascular procedures
● 24/7 availability of personnel, imaging, operating room and endovascular facilities
● ICU/neuroscience ICU facilities and capabilities
● experience and expertise treating patients with large ischemic strokes, intracerebral hemorrhage and subarachnoid hemorrhage
This certification is provided through a partnership between the American Heart Association/American Stroke Association and The Joint Commission, the nation's largest independent healthcare evaluation body.
● Learn more about Comprehensive Stroke Centers
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