Timeliness of Emergency Care for Intracerebral Hemorrhage Compared With Acute Ischemic Stroke.
13 affiliations
- 1Department of Emergency Medicine, University of Michigan, Ann Arbor.
- 2Department of Neurology, University of Michigan, Ann Arbor.
- 3Duke Clinical Research Institute, Duke, Durham, North Carolina.
- 4VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.
- 5Department of Neurology, Duke, Durham, North Carolina.
- 6Department of Neurology, University of Chicago, Chicago, Illinois.
- 7Department of Neurology, Northwestern University, Chicago, Illinois.
- 8Department of Cardiology, University of California at Los Angeles Medical Center.
- 9Department of Neurology, University of Pennsylvania, Philadelphia.
- 10Department of Emergency Medicine, Massachusetts General Hospital, Boston.
- 11Department of Neurology, University of California at Los Angeles Medical Center.
- 12Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
- 13Department of Neurology and Neurosurgery, Center for Brain and Mind Health, Yale School of Medicine, New Haven, Connecticut.
Abstract
Importance
Clinical data comparing time to presentation and stroke quality metrics for intracerebral hemorrhage (ICH) and acute ischemic stroke (AIS) are limited. Understanding these differences is essential to provide timely care to all stroke subtypes.Objective
To compare prehospital and emergency department (ED) process quality metrics between patients with ICH and AIS.Design, setting, and participants
Cohort study included patients with AIS and ICH admitted to Get With The Guidelines (GWTG)-Stroke participating hospitals from January 1, 2015, to June 30, 2024, who arrived by emergency medical services (EMS). Data were analyzed from 195 hospitals across the US.Main outcomes and measures
Prehospital-based and ED-based process metrics (eg, EMS prenotification, door to ED physician assessment time, door to initial brain imaging order) were assessed. Logistic and linear regression models were sequentially adjusted for patient demographics, medical history and presenting factors, and hospital characteristics. Temporal trends of prehospital care metrics were examined.Results
A total of 195 659 patients (median [IQR] age, 74.0 [63.0-83.0] years; 97 978 [50.1%] female; 31 464 with ICH and 164 195 with AIS) from 195 hospitals were included. The median (IQR) National Institutes of Health Stroke Scale (NIHSS) score was 14 (6-23) for ICH vs 6 (2-13) for AIS (absolute standardized difference, 0.694). ICH (vs AIS) was associated with higher odds of door-to-ED physician assessment of 10 or fewer minutes after adjusting for patient demographics (adjusted odds ratio [aOR], 1.08; 95% CI, 1.02-1.14). This association reversed after adding adjustment for medical history and presenting factors (including NIHSS) and hospital characteristics (aOR, 0.94; 95% CI, 0.89-0.99). This pattern was observed for door to initial brain imaging order of 20 or fewer minutes (demographic-adjusted: aOR, 1.09; 95% CI, 1.02-1.16; fully adjusted with medical history and hospital characteristics: aOR, 0.91; 95% CI, 0.85-0.97). Median last known well to arrival time increased by 32.5% for AIS (151 to 200 minutes; P < .001) and 34.3% for ICH (108 to 145 minutes; P < .001), while rates of EMS prenotification largely remained stable for both ICH and AIS.Conclusions and relevance
In this cohort study of patients with acute stroke, patients with ICH arrived at the ED faster but were less likely to achieve care targets. In the context of emerging hyperacute ICH therapies and bundled care models, addressing these differences is essential to optimizing acute stroke outcomes.
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BibTeX
@article{royan2026timeliness,
title = {{Timeliness of Emergency Care for Intracerebral Hemorrhage Compared With Acute Ischemic Stroke.}},
author = {Regina Royan and Uchechukwu Ikeaba and Brooke Alhanti and Brian Stamm and Brian Mac Grory and Shyam Prabhakaran and Matthew B Maas and Gregg C Fonarow and Steven R Messe and Lauren E Mamer and Joshua N Goldstein and Jeffrey L Saver and Eric E Smith and William J Meurer and Kevin N Sheth},
journal = {JAMA network open},
year = {2026},
month = oct,
doi = {10.1001/jamanetworkopen.2026.39429},
url = {https://europepmc.org/article/MED/42895744},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Timeliness of Emergency Care for Intracerebral Hemorrhage Compared With Acute Ischemic Stroke.
AU - Regina Royan
AU - Uchechukwu Ikeaba
AU - Brooke Alhanti
AU - Brian Stamm
AU - Brian Mac Grory
AU - Shyam Prabhakaran
AU - Matthew B Maas
AU - Gregg C Fonarow
AU - Steven R Messe
AU - Lauren E Mamer
AU - Joshua N Goldstein
AU - Jeffrey L Saver
AU - Eric E Smith
AU - William J Meurer
AU - Kevin N Sheth
PY - 2026
DA - 2026/10/01
JO - JAMA network open
DO - 10.1001/jamanetworkopen.2026.39429
UR - https://europepmc.org/article/MED/42895744
AB - Importance Clinical data comparing time to presentation and stroke quality metrics for intracerebral hemorrhage (ICH) and acute ischemic stroke (AIS) are limited. Understanding these differences is essential to provide timely care to all stroke subtypes.Objective To compare prehospital and emergency department (ED) process quality metrics between patients with ICH and AIS.Design, setting, and participants Cohort study included patients with AIS and ICH admitted to Get With The Guidelines (GWTG)-Stroke participating hospitals from January 1, 2015, to June 30, 2024, who arrived by emergency medical services (EMS). Data were analyzed from 195 hospitals across the US.Main outcomes and measures Prehospital-based and ED-based process metrics (eg, EMS prenotification, door to ED physician assessment time, door to initial brain imaging order) were assessed. Logistic and linear regression models were sequentially adjusted for patient demographics, medical history and presenting factors, and hospital characteristics. Temporal trends of prehospital care metrics were examined.Results A total of 195 659 patients (median [IQR] age, 74.0 [63.0-83.0] years; 97 978 [50.1%] female; 31 464 with ICH and 164 195 with AIS) from 195 hospitals were included. The median (IQR) National Institutes of Health Stroke Scale (NIHSS) score was 14 (6-23) for ICH vs 6 (2-13) for AIS (absolute standardized difference, 0.694). ICH (vs AIS) was associated with higher odds of door-to-ED physician assessment of 10 or fewer minutes after adjusting for patient demographics (adjusted odds ratio [aOR], 1.08; 95% CI, 1.02-1.14). This association reversed after adding adjustment for medical history and presenting factors (including NIHSS) and hospital characteristics (aOR, 0.94; 95% CI, 0.89-0.99). This pattern was observed for door to initial brain imaging order of 20 or fewer minutes (demographic-adjusted: aOR, 1.09; 95% CI, 1.02-1.16; fully adjusted with medical history and hospital characteristics: aOR, 0.91; 95% CI, 0.85-0.97). Median last known well to arrival time increased by 32.5% for AIS (151 to 200 minutes; P < .001) and 34.3% for ICH (108 to 145 minutes; P < .001), while rates of EMS prenotification largely remained stable for both ICH and AIS.Conclusions and relevance In this cohort study of patients with acute stroke, patients with ICH arrived at the ED faster but were less likely to achieve care targets. In the context of emerging hyperacute ICH therapies and bundled care models, addressing these differences is essential to optimizing acute stroke outcomes.
SN - 2574-3805
ER -