Rates of Adverse Events and Outcomes among Stroke Patients Admitted to Primary Stroke Centers Saqib A. Chaudhry, MD,* Mohammad R. Afzal, MD,† Burhan Z. Chaudhry, MD,‡ Taqi T. Zafar, MD,† Adnan Safdar, MD,* Mounzer Y. Kassab, MD,* Syed I. Hussain, MD,* and Adnan I. Qureshi, MD† Background and purpose: To identify the beneficial effects of primary stroke centers (PSCs) certification by Joint Commission (JC), we compared the rates of in- hospital adverse events and discharge outcomes among ischemic stroke patients admitted to PSCs and those admitted to non-PSC hospitals in the United States. Methods: We obtained the data from the Nationwide Inpatient Sample from 2010 and 2011. The analysis was limited to states that publicly reported hospital identity. PSCs were identified by matching the Nationwide Inpatient Sample hospital files with the list provided by JC. The analysis was limited to patients (age ≥18 years) discharged with a principal diagnosis of ischemic stroke (International Classification of Disease, 9th Revision, codes 433.x1, 434.x1). Results: We identified a total of 123,131 ischemic stroke patients from 28 states. A total of 72,982 (59.3%) patients were admitted to PSCs. After adjusting for age, gender, race or ethnicity, comorbidities, All Patients Refined Diagnosis Related Groups (APR-DRG)-based disease severity, and hospital teaching status, patients admitted to PSCs were at lower risk of in-hospital adverse events complications: pneumonia (odds ratio [OR], .8; 95% confidence interval [CI], .7-.8) and sepsis (OR, .7; 95% CI, .6-.8). Patients admitted to PSCs were more likely to receive thrombolysis (OR, 1.6; 95% CI, 1.5-1.7). The mean cost of hospitalization (95% CI) of the patients was significantly higher in patients admitted at PSCs com- pared with those admitted at non PSC hospitals $47621 (47099-48144) vs. $35229 (34803-35654), P < .0001). The patients admitted to PSCs had lower inpatient mor- tality (OR, .8; 95% CI, .8-.9) and were more likely to be discharged with none to minimal disability (OR, 1.1; 95% CI, 1.0-1.1). Conclusions: Compared with non- PSC admissions, patients admitted to PSCs are less likely to experience hospital From the *Department of Neurology and Ophthalmology, Michigan State University, East Lansing, Michigan; †Zeenat Qureshi Stroke Institute, St Cloud, Minnesota; and ‡Department of Neurology, Cleveland Clinic, Lakewood, Ohio. Received November 24, 2015; revision received January 20, 2016; accepted January 29, 2016. Disclosures: None. This study was not sponsored by any grantor pharmaceutical company. Conflict of interest: None. Author contributions: Saqib A. Chaudhry: study concept and design, analysis and interpretation, and critical revision of the manuscript for important intellectual content. Mohammad R. Afzal: acquisition of data, analysis, and interpretation. Burhan Z. Chaudhry MD: critical revi- sion of the manuscript for important intellectual content. Taqi T. Zafar: acquisition of data, analysis, and interpretation. Adnan Safdar: critical revision of the manuscript for important intellectual content. Mounzer Y. Kassab: critical revision of the manuscript for important intellectual content. Syed I. Hussain: critical revision of the manuscript for important intellectual content. Adnan I. Qureshi: critical revision of the manu- script for important intellectual content, and study supervision. Address correspondence to SaqibA. Chaudhry, MD, Department of Neurology and Ophthalmology, Clinical Center, Michigan State University, 804 Service Road, Room A-217, East Lansing, MI 48824.E-mail: chaudhrys208@gmail.com. 1052-3057/$ - see front matter © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2016.01.045 ARTICLE IN PRESS Journal of Stroke and Cerebrovascular Diseases, Vol. ■■, No. ■■ (■■), 2016: pp ■■–■■ 1