(Press-News.org) DALLAS, May 6, 2015 -- People with hemorrhagic strokes (brain bleeds) are more likely to survive if they are treated at a comprehensive stroke center, according to 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. When a person is diagnosed with a hemorrhagic stroke, loved-ones should ask about the possibility of a transfer," said 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.
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) and to 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:
a 7 percent reduced risk of death for patients with all hemorrhagic strokes;
a 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);
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, with patients transferred within 24 hours 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.
INFORMATION:
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.
Additional Resources:
Learn more about strokes.
Learn more about Comprehensive Stroke Centers
Follow AHA/ASA news on Twitter @HeartNews.
For updates and new science from JAHA, follow @JAHA_AHA.
Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association's policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at http://www.heart.org/corporatefunding.
Insurance coverage has increased across all types of insurance since the major provisions of the federal Affordable Care Act took effect, with a total of 16.9 million people becoming newly enrolled through February 2015, according to a new RAND Corporation study.
Researchers estimate that from September 2013 to February 2015, 22.8 million Americans became newly insured and 5.9 million lost coverage, for a net of 16.9 million newly insured Americans.
Among those newly gaining coverage, 9.6 million people enrolled in employer-sponsored health plans, followed by Medicaid ...
Psychologists are to improve online health information on lung cancer after research showed that family members are more likely to search online to encourage loved ones to seek help.
This is one of the outcomes from research by PhD student Julia Mueller based in the School of Nursing, Midwifery and Social Work at The University of Manchester (part of the Manchester Cancer Research Centre) who will present her study today, Thursday 7 May 2015, at the Annual Conference of the British Psychology Society being held in Liverpool.
Julia Mueller said: "People displaying ...
The ulcer-causing bacterium Helicobacter pylori can directly interact with stomach stem cells, causing the cells to divide more rapidly, according to a new study by researchers at the Stanford University School of Medicine.
The increased cell division was observed in mice, but the findings could explain why H. pylori is a risk factor for gastric cancer in humans, the researchers said.
They used 3-D microscopy to identified colonies of the bacteria deep within human stomach glands, where stem cells and precursor cells that replenish the stomach's lining reside.
One ...
MADISON, Wis. -- The suspicion that the federal Affordable Care Act reduces options for patients to choose their health care providers proves to be true, according to a new study co-authored by David Weimer, a professor with the La Follette School of Public Affairs at the University of Wisconsin-Madison. However, the quality of hospitals in insurance exchange networks was as good or better than those in commercial insurance networks.
The study, just published in the May issue of the journal Health Affairs, compared the hospital networks available to California consumers ...
Creative athletes have been using geographic information systems to transform their running routes into kangaroos, robots and other works of art that they share online, and one romantic cyclist last year even spelled out "Will you marry me, Emily?" with his bike.
A new mobile app developed at the University of Washington does the opposite. The Trace app turns a digital sketch that you draw on your smartphone screen -- a heart, maple leaf, raindrop, sailboat -- into a walking route that you can send to a friend or loved one. The recipient of the "gift" tells the app how ...
Scientists at the National Institutes of Health have solved a long-standing mystery about the origin of one of the cell types that make up the ovary. The team also discovered how ovarian cells share information during development of an ovarian follicle, which holds the maturing egg. Researchers believe this new information on basic ovarian biology will help them better understand the cause of ovarian disorders, such as premature ovarian failure and polycystic ovarian syndrome, conditions that both result in hormone imbalances and infertility in women.
Researchers at the ...
The Alaska salmon fishery is touted as one of the best in the world. When measured with an ecological yardstick, it is - fish stocks are healthy and the fishery is certified by the Marine Stewardship Council as consistently meeting rigorous biological standards. Fish are individually counted as they swim upstream to ensure there are enough to breed.
But Alaska salmon falls short and lags behind some of the world's fisheries in how it benefits local fishermen, processing workers and nearby rural communities, according to a new assessment that ranks the vitality of a fishery ...
Diets of snakes from a temperate region in South America may depend more on phylogeny (ancestry) than ecology, according to a study published May 6, 2015 in the open-access journal PLOS ONE by Gisela Bellini from Instituto Nacional de Limnología, Argentina and colleagues.
Some scientists believe that the deep history hypothesis based on phylogeny -- the history of evolution, or ancestry and relationships between snakes -- and ecological interactions from the competition-predation hypothesis may act together to determine the structure of snake communities. The authors ...
Post-surgical leaks that develop after a segment of the colon has been removed and stitched back together often are caused not by negligence or technical error but by bacteria in the bowel that elude antibiotics, according to new evidence about this devastating complication of gastrointestinal surgery.
Such leaks, which can develop days or weeks after the procedure, allow the bowel's contents to spill into the abdomen and can cause pain, fever, sepsis and even death.
In patients undergoing high risk surgery such as in the rectum, leak rates can approach 30 percent. ...
Berkeley -- A research team led by engineers at the University of California, Berkeley, has developed a new mobile phone microscope that uses video to automatically detect and quantify infection by parasitic worms in a drop of blood. This next generation of UC Berkeley's CellScope technology could help revive efforts to eradicate debilitating diseases in Africa by providing critical information for health providers in the field.
"We previously showed that mobile phones can be used for microscopy, but this is the first device that combines the imaging technology with ...
