Emergency Care Timeliness for Intracerebral Hemorrhage vs Ischemic Stroke

Patients with intracerebral hemorrhage (ICH) reached the emergency department (ED) faster than those with acute ischemic stroke (AIS) but, after adjustment for stroke severity and hospital factors, were less likely to meet 2 ED time targets, according to a cohort study published in JAMA Network Open.

The investigators analyzed 195,659 patients who arrived by emergency medical services (EMS) at 195 US hospitals in the Get With The Guidelines–Stroke registry from January 2015 to June 2024; 31,464 had ICH and 164,195 had AIS. Median National Institutes of Health Stroke Scale (NIHSS) score was 14 for ICH and 6 for AIS. Models were sequentially adjusted for demographics, medical history and presenting factors including NIHSS score, and hospital characteristics.

Patients with ICH had shorter median times from last known well to arrival (127 vs 175 minutes) and from symptom onset to arrival (71 vs 87 minutes), and both differences remained significant after full adjustment. EMS prenotification did not differ significantly (69.2% vs 69.0%). In the ED, ICH was associated with higher odds of ED physician assessment within 10 minutes after adjustment for demographics alone, but the association reversed after full adjustment (adjusted odds ratio [aOR], 0.94; 95% CI, 0.89-0.99). Brain imaging ordered within 20 minutes followed the same pattern (fully adjusted aOR, 0.91; 95% CI, 0.85-0.97). The other 4 ED metrics, including stroke team activation and imaging report times, did not differ significantly after full adjustment.

In an exploratory analysis, NIHSS score accounted for the reversal. The authors noted that many sites were excluded for incomplete stroke team activation data, which may limit generalizability; that residual confounding was possible; that NIHSS was used rather than ICH score; and that the registry lacks data on prehospital airway and breathing assessments, which may have delayed stroke care for more severely ill patients with ICH.

The authors concluded that national quality improvement initiatives should be extended to ICH, especially as evidence grows for time-sensitive therapies.

Source: Royan R, Ikeaba U, Alhanti B, et al. Timeliness of emergency care for intracerebral hemorrhage compared with acute ischemic stroke. JAMA Netw Open. 2026;9(10):e2639429. doi:10.1001/jamanetworkopen.2026.39429