Abstract
Background and Aim: Performance measures have been extensively studied for acute ischemic stroke, leading
to guideline-established benchmarks. Factors influencing care efficiency for intracerebral
hemorrhage (ICH) are not well delineated. We sought to identify factors associated
with early recognition of ICH and to assess the association between early recognition
and completion of emergency care tasks. Methods: Consecutive patients with spontaneous ICH were enrolled in an observational cohort
study conducted from 2009 to 2017 at an urban comprehensive stroke center, excluding
patient transferred from other hospitals. We used stroke team activation as the indicator
of early recognition and measured completion times for multiple ICH-relevant performance
metrics including door to computed tomography (CT) acquisition and door to hemostatic
medication initiation. Results: We studied 204 cases. All stroke-related performance times were faster in patients
managed with stroke team activation compared to no activation, including quicker door
to CT acquisition (median 24 versus 48 minutes, P < .001) and door to hemostatic medication initiation (63 versus 99 minutes, P = .005). These associations were confirmed in adjusted models. Stroke codes were
activated in 43% of cases and were more likely in patients with shorter onset-to-arrival
times, higher National Institutes of Health Stroke Scale scores, and higher Glasgow
Coma Scale scores. Conclusions: Stroke team activation was associated with more rapid diagnostic and therapeutic
interventions for patients with ICH, but activation did not occur in the majority
of cases, implying absence of early recognition. A stroke team activation process
improves care performance, but leveraging the advantages of existing systems will
require improved triage tools to identify ICH in the acute setting.
Key Words
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Article info
Publication history
Published online: December 12, 2019
Accepted:
November 21,
2019
Received:
July 16,
2019
Footnotes
Funding: This work was supported by National Institutes of Health grants K23NS092975 and UL1TR000150 and Agency for Healthcare Research and Quality grant K18HS023437.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104552
Copyright
© 2019 Elsevier Inc. All rights reserved.
