Time for "code ICH"? - Workflow metrics of hyperacute treatments and outcome in patients with intracerebral haemorrhage.

IF 2.2 3区医学 Q3 CLINICAL NEUROLOGY

Cerebrovascular Diseases Pub Date : 2024-01-10 DOI:10.1159/000536099

Eva Bettschen, Bernhard M Siepen, Martina B Goeldlin, Madlaine Mueller, Philipp Buecke, Ulrike Prange, Thomas R Meinel, Boudewijn R H Drop, David Bervini, Tomas Dobrocky, Johannes Kaesmacher, Aristomenis K Exadaktylos, Thomas C Sauter, Bastian Volbers, Marcel Arnold, Simon Jung, Urs Fischer, Werner Z'Graggen, David Seiffge

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引用次数: 0

Abstract

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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是时候进行 "代码 ICH "了？- 脑出血患者超急性期治疗和预后的工作流程指标。

简介：有关急诊科非外伤性脑出血（ICH）患者超急性期治疗的接受度和工作流程指标的知识非常缺乏：有关急诊科非外伤性脑出血（ICH）患者超急性期治疗的接受度和工作流程指标的知识十分匮乏：方法：对2018年1月至2020年8月期间的连续ICH患者进行单中心回顾性研究。我们根据转诊模式（卒中代码、从其他医院转入或其他）评估了急性疗法的总体吸收率和工作流程指标：我们招募了 332 名患者（年龄 73 岁，IQR 63-81；GCS 14 分，IQR 11-15；发病至入院时间 284 分钟，IQR 111-708分钟），其中 101 名患者（35%）患有脑叶血肿。129 名患者（38%）的转诊方式为卒中代码，143 名患者（43%）的转诊方式为其他医院转诊，60 名患者（18%）的转诊方式为其他途径。总体而言，216 名收缩压大于 150mmHG 的患者中有 143 名（66%）接受了静脉降压治疗，76 名口服抗凝治疗的患者中有 67 名（88%）接受了凝血酶原复合物浓缩物治疗（PCC）。46名患者（14%）在入院后3小时内接受了任何神经外科干预。从入院到首次静脉注射抗高血压治疗的中位治疗时间为 38 分钟（IQR 18-72 分钟），凝血酶原复合物浓缩物治疗的中位治疗时间为 59 分钟（IQR 37-111 分钟），转诊方式不同，中位治疗时间也有显著差异（P结论：急诊室采用超急性疗法治疗 ICH 的情况各不相同。治疗延迟时间较短，但并非所有患者都能在急诊室住院期间达到治疗目标。规范的 ICH 协调治疗可改善临床疗效。倡导 "ICH代码 "以简化急性治疗，似乎可以实现进一步的改善。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cerebrovascular Diseases 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

审稿时长

1 months

期刊介绍： A rapidly-growing field, stroke and cerebrovascular research is unique in that it involves a variety of specialties such as neurology, internal medicine, surgery, radiology, epidemiology, cardiology, hematology, psychology and rehabilitation. ''Cerebrovascular Diseases'' is an international forum which meets the growing need for sophisticated, up-to-date scientific information on clinical data, diagnostic testing, and therapeutic issues, dealing with all aspects of stroke and cerebrovascular diseases. It contains original contributions, reviews of selected topics and clinical investigative studies, recent meeting reports and work-in-progress as well as discussions on controversial issues. All aspects related to clinical advances are considered, while purely experimental work appears if directly relevant to clinical issues.