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Updated: Jun 17, 2026
09:21
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Hospital stroke volume and case-fatality revisited
Uzor C Ogbu1, Laurentius C J Slobbe, Onyebuchi A Arah
1Department of Social Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. u.c.ogbu@amc.uva.nl
Medical Care
|January 9, 2010
Summary
Stroke patients treated at high-volume hospitals have a lower risk of death. However, the study suggests a volume-based referral strategy may not be practical for improving stroke care outcomes.
Area of Science:
- Neurology
- Public Health
- Health Services Research
Background:
- Previous studies suggest an inverse relationship between hospital patient volume and stroke case-fatality.
- Inconsistencies in stroke categorizations across studies may affect findings.
- The clinical significance of observed associations is debated, questioning volume-based referral policies.
Purpose of the Study:
- To re-examine the association between hospital stroke volume and case-fatality.
- To assess the influence of different volume categorizations on this association.
- To evaluate the implications of volume-based referral strategies for stroke care.
Main Methods:
- Multilevel logistic regression analysis.
- Utilized admissions data from Statistics Netherlands (2000-2004) for 73,077 stroke patients.
- Employed various cut-offs to categorize hospitals into volume groups.
Main Results:
- Patients in high-volume hospitals demonstrated a reduced risk of 7-day mortality.
- Odds ratios varied based on volume categorization, e.g., 0.45 (high vs. low >200 vs. <50 cases).
- A referral policy to >200 case-volume hospitals could save 183 lives; a nontransfer policy could save 1260 lives.
Conclusions:
- Higher odds of mortality exist for stroke patients in low-volume versus high-volume hospitals.
- The findings indicate that a substantial volume-based referral strategy may not be feasible.
- Further consideration of factors beyond volume is needed for optimizing stroke patient outcomes.
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