Introduction:
Knowledge about uptake and workflow metrics of hyperacute treatments in
patients with non-traumatic intracerebral haemorrhage (ICH) in the
emergency department are scarce.
Methods:
Single centre retrospective study of consecutive patients with ICH
between 01/2018-08/2020. We assessed uptake and workflow metrics of
acute therapies overall and according to referral mode (stroke code,
transfer from other hospital or other).
Results:
We enrolled 332 patients (age 73years, IQR 63-81 and GCS 14 points, IQR
11-15, onset-to-admission-time 284 minutes, IQR 111-708minutes) of whom
101 patients (35%) had lobar haematoma. Mode of referral was stroke code
in 129 patients (38%), transfer from other hospital in 143 patients
(43%) and arrival by other means in 60 patients (18%).
Overall, 143 of 216 (66%) patients with systolic blood pressure
>150mmHG received IV antihypertensive and 67 of 76 (88%) on
therapeutic oral anticoagulation received prothrombin complex
concentrate treatment (PCC). Forty-six patients (14%) received any
neurosurgical intervention within 3 hours of admission.
Median treatment times from admission to first IV-antihypertensive
treatment was 38 minutes (IQR 18-72minutes) and 59 minutes (IQR 37-111
minutes) for PCC, with significant differences according to mode of
referral (p<0.001) but not early arrival (≤6hours of onset, p=0.92).
The median time in the emergency department was 139 minutes (IQR 85-220
minutes) and among patients with elevated blood pressure, only 44%
achieved a successful control (<140mmHG) during ED stay. In
multivariate analysis, code ICH concordant treatment was associated with
significantly lower odds for in-hopsital mortality (aOR 0.30, 95%CI
0.12-0.73, p=0.008) and a non-significant trends towards better
functional outcome measured using the modified Rankin scale score at 3
months (aOR for ordinal shift 0.54 95%CI 0.26-1.12, p=0.097).
Conclusion:
Uptake of hyperacute therapies for ICH treatment in the ED is
heterogeneous. Treatment delays are short but not all patients achieve
treatment targets during ED stay. Code ICH concordant treatment may
improve clinical outcomes. Further improvements seem achievable
advocating for a “code ICH” to streamline acute treatments.
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