Intracerebral hemorrhage hospitalizations and outcomes: comparisons between institutional and national data

Intracerebral hemorrhage (ICH) accounts for 10-15% of all strokes in the United States (US), with in-hospital mortality rates reaching 40-50%. This study addresses a critical gap in understanding ICH outcomes in Alabama, where data has historically been absent from the National Inpatient Sample (NIS), despite the state's high burden of stroke incidence and mortality. To compare in-hospital mortality rates and length of stay (LOS) among patients with ICH treated at a comprehensive stroke center in Alabama versus large urban hospitals across the US, we conducted a retrospective analysis of data from 425 ICH patients treated at the academic comprehensive stroke center in Alabama (2016-2019) and 68,525 patients from the NIS (2016-2018). Patients were aged 18 and older with a diagnosis of ICH. We utilized multivariable logistic regression to assess mortality and linear regression for LOS, adjusting for demographics and procedures. The patients at the Alabama center were generally younger, white, and more likely to be females. The comprehensive stroke center reported an in-hospital mortality rate of 27.76 per 100 patients (95% CI = 22.76, 32.77), which was higher than the NIS average of 22.02 per 100 patients (95% CI = 21.69, 22.37). Additionally, patients at the Alabama center had 33.5% higher odds of in-hospital mortality compared to South Atlantic hospitals (OR = 1.34, 95% CI = 1.07-1.67, p = 0.0113). Lastly, the comprehensive stroke center demonstrated a significantly shorter LOS of 5.8 days (β = - 1.25; 95% CI = - 1.89, - 0.61; p = 0.0001) compared to the South Atlantic hospitals.