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Association between Subarachnoid Hemorrhage Outcomes
and Number of Cases Treated at California Hospitals
Bardach NS, et al.
Stroke. 2002 Jul; 33(7):1851-6.
OBJECTIVE:
To determine if patients with subarachnoid hemorrhage
treated at high-volume hospitals have better outcomes.
METHODS:
The discharge abstracts for all patients with a primary
diagnosis of subarachnoid hemorrhage admitted to nonfederal
hospitals in California from 1990 to 1999 were analyzed.
Hospital volume, defined as the average number of subarachnoid
hemorrhage cases admitted each year, was divided into
quartiles. A total of 12,804 patients were admitted
for subarachnoid hemorrhage through the emergency departments
of 390 hospitals. Mortality rate, adverse events, lengths
of stay and hospital charges were evaluated.
RESULTS:
The mortality rate in the lowest volume quartile (49%)
was larger than that in the highest volume quartile
(32%). For any given annual case volume used to divide
hospitals into high- and low-volume groups, the odds
ratio of in-hospital mortality shows a decreased risk
of death in the high-volume hospitals. With a definition
of high-volume of at least 21 cases, the odds ratio
of in-hospital mortality was at least 40% lower at high-volume
hospitals.
CONCLUSION:
Hospitals that treated more cases of subarachnoid
hemorrhage had substantially lower rates of in-hospital
mortality.
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