More Evidence to Support Referral to Specialized Stroke Centers

Seemant Chaturvedi, MD

An analysis of outcomes from reorganization of two urban stroke systems in England

The approval of thrombolysis has challenged hospitals to reconfigure their emergency services to provide timely treatment to patients with acute stroke. After the finding that treatment with thrombolysis at specialized centers is associated with reduced mortality, discussion intensified regarding selective referral to certified stroke centers. To evaluate whether reconfiguration of stroke protocols in two large cities (London and Manchester) in England was associated with changes in mortality and length of hospital stay, researchers conducted an observational study of 258,915 patients referred to hyperacute stroke centers or primary stroke centers over a 5-year period spanning the periods before and after protocol changes to a hub-and-spoke model of stroke care.

In London, 90-day stroke mortality was a significant 1.1% lower than in the rest of England after service reconfiguration, whereas no difference from the rest of England was seen in Manchester. Risk-adjusted length of hospital stay was significantly lower in both cities compared with the rest of England (1.4–2.0 days' difference) after the system changes. The reduction in mortality in London was significant only for ischemic stroke patients. Reduction in length of stay (in both cities compared with the rest of England) was significant only for ischemic stroke (1.4–2.6 days' difference).

Citation(s):

Morris S et al. Impact of centralising acute stroke services in English metropolitan areas on mortality and length of hospital stay: Difference-in-differences analysis. BMJ 2014 Aug 5; 349:g4757.