Response to: Relationship between hospital size, remoteness and stroke outcome

Abstract

We thank Dr Liu and Dr Wang for their consideration of our paper. In response to some of their comments, as the paper makes clear, the study was conducted in only Ischaemic strokes (1). Because of the small size of some of the participating hospitals and the smaller proportion of haemorrhagic strokes calculations of adjusted mortality rate are less precise in the haemorrhagic stroke population. There are also fewer effective acute interventions for intracerebral haemorrhage thus measures of process such as thrombolysis rate and door to needle time would not be pertinent to them. Subsequent analyses of the data have found that in fact Remote hospitals in Ireland see a lower proportion of haemorrhagic strokes and care for a slightly older population (2) but both of these factors were controlled for in the study.</p