Abstract Details

Title Criteria for management of spontaneous intracerebral hemorrhage without quaternary referrals

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) Neurocritical Care Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 002

Objective Given the risk of worsening intracerebral hemorrhage (ICH) and potential need for neurosurgical intervention, most referring hospitals have protocols for automatic transfer of patients with ICH to a neuroscience intensive care unit (ICU) for close patient monitoring and availability of neurosurgery. Inter-facility transfers are undertaken at often significant financial and/or emotional cost to patients and their families. This study aims to determine if previously published criteria for patients with spontaneous ICH able to be safely managed without transfer to a neuroscience ICU apply to our patient population.

Background The previously published criteria are: hemorrhage in a supratentorial location, hemorrhage volume < 20cc, no intraventricular hemorrhage, no need for mechanical ventilation, and Glasgow Coma Scale ≥ 12.

Design/Methods Data was obtained retrospectively by chart review following IRB approval. Adult patients with spontaneous ICH treated in our quaternary care center were included. Patients meeting the previously defined stepdown criteria were further assessed to determine the frequency at which their condition required ICU level care.

Results For the years 2014 - 2019, we identified 46 patients who fulfilled the pre-specified stepdown criteria and 202 who did not. 40 patients were transferred from outside hospitals. No patients deteriorated neurologically, though one had clinically insignificant expansion of hemorrhage. Zero patients required neurosurgical intervention or intubation during their hospitalization.

Conclusions Preliminary data from our study validates previously published criteria for ICH patients who are able to be safely managed outside of a specialized neuroscience ICU. Where available, additional specialized support via telemedicine services could further augment the quality of remote care for medically well patients with small ICH. With broad application of these criteria across our referral system, at least 40 patient transfers could have been prevented during our study period. Reducing the frequency of these transfers can lower cost of care without exposing our patients to increased risk of harm.

Authors/Disclosures
Leighton Mohl, MD (Sanford Hospital) PRESENTER	Dr. Mohl has nothing to disclose.
	No disclosure on file

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