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 than patients with AIS.
Among 195,659 EMS-transported stroke patients across 195 GWTG-Stroke hospitals, ICH patients presented with substantially greater stroke severity than AIS patients.
After adjustment for patient demographics only, ICH was associated with higher odds of door-to-ED physician assessment within 10 minutes compared with AIS.
The association for door-to-ED physician assessment within 10 minutes reversed after adjusting for medical history, presenting factors (including NIHSS), and hospital characteristics, with ICH having lower odds than AIS.
The same pattern was seen for door-to-initial brain imaging order within 20 minutes: ICH had higher odds after demographic adjustment but lower odds after full adjustment.
Median last known well to arrival time increased over the study period for both AIS and ICH.
Rates of EMS prenotification largely remained stable over time for both ICH and AIS.
Patients with ICH arrived faster but were less likely to meet ED care targets, which the authors say needs addressing given emerging hyperacute ICH therapies and bundled care models.
This study compared how quickly people with two types of stroke received emergency care: bleeding in the brain (intracerebral hemorrhage, or ICH) and stroke caused by a blocked blood vessel (acute ischemic stroke, or AIS). It used data on nearly 196,000 patients who came by ambulance to 195 U.S. hospitals between 2015 and 2024. ICH patients were generally much sicker on arrival and reached the hospital sooner after last being seen well. Despite arriving faster, ICH patients were somewhat less likely to be seen by an emergency physician within 10 minutes or to have brain imaging ordered within 20 minutes once differences in patient and hospital characteristics, including stroke severity, were accounted for. Before that full adjustment, ICH patients appeared slightly more likely to meet these targets. Over the decade, the time from last known well to arrival got longer for both stroke types by about a third, and ambulance prenotification of hospitals stayed roughly flat. This research suggests that emergency care for ICH may lag behind care for ischemic stroke, even though ICH patients arrive quickly. As new fast-acting ICH treatments and coordinated care approaches emerge, the authors suggest that closing these gaps could help improve outcomes. This was an observational study, so it shows associations rather than causes.
Royan R, Ikeaba U, Alhanti B, Stamm B, Mac Grory B, Prabhakaran S, et al.. (2026). Timeliness of Emergency Care for Intracerebral Hemorrhage Compared With Acute Ischemic Stroke.. JAMA network open. https://doi.org/10.1001/jamanetworkopen.2026.39429