Abstract
Objectives
The management of patients admitted with intracerebral hemorrhage (ICH) mostly occurs
in an ICU. While guidelines recommend initial treatment of these patients in a neurocritical
care or stroke unit, there is limited data on which patients would benefit most from
transfer to a comprehensive stroke center where on-site neurosurgical coverage is
available 24/7. As neurocritical units become more common in primary stroke centers,
it is important to determine which patients are most likely to require neurosurgical
intervention and transfer to comprehensive stroke centers.
Materials and methods
This is a retrospective observational cohort study conducted at an academic comprehensive
stroke center in the United States. Four-hundred-fifty-nine consecutive patients transferred
or directly admitted to the neurocritical care unit from 2016–2018 with the primary
diagnosis of ICH were included. Univariate statistics and multivariate regression
were used to identify clinical characteristics associated with neurosurgical intervention,
defined as undergoing craniotomy, ventriculostomy, or endovascular embolization of
an arteriovenous malformation (AVM).
Results
The following variables were associated with neurosurgical intervention in multivariate
analysis: age (OR 0.38, 95% CI 0.27–0.55), admission Glasgow Coma Scale (OR 0.29,
95% CI 0.18–0.48), the presence of intraventricular hemorrhage (OR 2.82, CI 1.71–4.65),
infratentorial location of ICH (OR 2.28, 95% CI 1.20–4.31), previous antiplatelet
use (OR 2.04, 95% CI 1.24–3.34), and an AVM indicated on CT Angiogram (OR 2.59, 95%
CI 1.19–5.63) were independently associated with the need for neurosurgical intervention.
This was translated into a scoring system to help make quick triage decisions, with
high sensitivity (99%, 95% CI 97–99%) and negative predictive value (98%, 95% CI 89–99%).
Conclusions
Using previously well described predictors of severity in ICH patients, we were able
to develop a scoring system to predict the need for neurosurgical intervention with
high sensitivity and negative predictive value.
Key Words
Abbreviations:
ICH (Intracerebral hemorrhage), AVM (Arteriovenous malformation), AHA (American Heart Association), ICU (Intensive care unit)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 14, 2021
Accepted:
February 5,
2021
Received in revised form:
January 28,
2021
Received:
November 16,
2020
Footnotes
Research performed at: University of Maryland Medical Center
Subject Terms: health services, intracranial hemorrhage, diagnostic testing
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105672
Copyright
© 2021 Elsevier Inc. All rights reserved.
