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P239 BACKGROUND: Whether admission of stroke patients  to neurologists is associated with improved outcomes is uncertain.  Though prior studies suggested ischemic stroke patients under the care  of neurologists had lower rates of in-hospital mortality than those  treated by internists, these studies were uncontrolled for the  possibility that patients with better prognosis were admitted to  neurologists.METHODS: The University HealthSystem  Consortium administrative database contains patient information from 84  large academic health centers and associates. Discharge abstracts for  ischemic strokes admitted through emergency rooms 1997–1999 were  obtained. Database variables were validated by comparison with a  detailed chart review of 927 patients at 36 institutions. Attending  physician specialty was evaluated as a predictor of in-hospital  mortality using chi-square statistics and multivariable logistic  regression. To determine whether hospital rates of stroke admission to  neurologists were predictive of in-hospital mortality, generalized  estimating equations (GEE) were used. This multivariable method  accounts for clustering of observations at institutions, which broadens  confidence intervals (CI). All multivariable analyses were adjusted for  age, gender, race, admission status, and treatment volume.RESULTS: Of 28,571 ischemic strokes admitted through the  emergency department, 58% were admitted to neurologists. Univariate  analyses demonstrated a lower risk of in-hospital mortality in cases  admitted to neurologist (4.7%) compared to non-neurologists (9.4%;  p&lt;0.001). Adjustment for case-mix did not alter the association (odds  ratio, 0.48; 95% CI, 0.43–0.53; p&lt;0.001). However, risk of death was  not lower at hospitals admitting a larger portion of ischemic stroke  cases to neurologists (p=0.54) as would be expected if admission to  neurologists led to improved outcomes.CONCLUSIONS: In  academic medical centers, ischemic stroke patients admitted to  neurologists are less likely to die in the hospital compared to those  admitted to other services. However, this may be due to selection of  patients with better prognosis for admission to  neurologists.

Are Outcomes of Ischemic Strokes Improved When a Neurologist is Attending?