To achieve designation as a stroke center, a hospital must comply with 11 crucial features of stroke care, such as having distinct stroke teams, protocols, and continuing medical education programs. Yet little research has proven that these measures translate into better patient outcomes, particularly mortality rates, than does treatment at a hospital that doesn't carry stroke center designation.

Using patient data from 2005 and 2006 on all hospital admissions involving ischemic stroke in the state of New York, researchers investigated all-cause mortality from stroke at days 1, 7, and 30 and at one year after admission to either a designated stroke center or a nondesignated center. An adjusted analysis was performed taking into account any extra distance to a stroke center, compared with the hospital closest to the patient's home.

Nearly 31,000 records were examined: 49.4% were admitted to stroke centers (n = 15,297) and 50.6% to nondesignated hospitals (n = 15,650); the unadjusted 30-day all-cause mortality rates were 10.1% and 12.5%, respectively. The adjusted analysis revealed that admission to a stroke center was associated with a 2.5% absolute decrease in 30-day mortality. The stroke centers also achieved lower mortality rates than nondesignated centers at the day 1 (0.3% lower), day 7 (1.3% lower) and one year (3% lower) marks. Patients were treated more often with thrombolytics at stroke centers (4.8%) than at other hospitals (1.7%).

A secondary analysis involving two other conditions, myocardial infarction and gastrointestinal hemorrhage, revealed no differences in 30-day all-cause mortality at these same two types of centers, suggesting that the researchers' findings were unique to stroke care.-AK

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