JAMA Netw Open. 2026 Oct 1;9(10):e2639429. doi: 10.1001/jamanetworkopen.2026.39429.
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.
PMID:42895744 | DOI:10.1001/jamanetworkopen.2026.39429