Abstract Details

Title ICH Triage Score: Predictors of Safe Floor Admission for Patients with Intracerebral Hemorrhage

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S12 - (-)

Poster/Presentation
Number 002

Objective

Background The current guidelines recommend ICH patients to be initially managed in a neuroscience intensive care unit (NSICU). However, in a geographically isolated region with limited NSICU capacity, not every ICH patient can be triaged to the NSICU. Currently, there is no triage algorithm for the ICH patients in an environment where allocation of NSICU resources is at times needed.

Design/Methods Consecutive patients hospitalized for ICH between 2006 and 2010 were studied. A chart review was performed to assess whether each patient would have been safely managed with floor-level care based on predefined criteria. Multivariable logistic regression models were used to test for predictors of appropriate floor-level admission, adjusted for each component of the ICH Score, transfer from another hospital, initial systolic blood pressure (SBP) >160 mmHg and SBP >180 mmHg.

Results Among a total of 397 consecutive patients hospitalized for ICH, 47 patients were excluded due to significant coagulopathy and 38 patients were excluded since they were admitted to the floor for comfort measures only. Among the remaining eligible 312 ICH patients, 133 patients (43%) were considered appropriate for floor-level care on admission. Predictors of safe floor admission in a logistic regression model were initial GCS 13-15 (OR 11.2, 95% CI: 5.7 to 22.2), ICH volume <30 cm3 (OR 5.0, 95% CI: 2.4 to 10.6), absence of intraventricular hemorrhage (OR 3.6, 95% CI: 1.9 to 7.0), absence of infratentorial hemorrhage (OR 2.8, 95% CI: 1.1 to 6.8), and age ? 80 years (OR 2.9, 95% CI: 1.2 to 7.0). This model had an area under the receiver operating characteristic curve of 0.87.

Conclusions A simple triage scoring system can be developed for ICH patients as an initial guide to determine the level of care on admission.

Authors/Disclosures
Kazuma Nakagawa, MD, FAAN (The Queen'S Medical Center) PRESENTER	Dr. Nakagawa has nothing to disclose.
Megan A. Vento (The Queens Medical Center)	No disclosure on file
	No disclosure on file
Susan M. Asai (The Queen'S Medical Center)	No disclosure on file
Matthew A. Koenig, MD (The Queen's Medical Center)	No disclosure on file
Cherylee Chang, MD (Duke University)	No disclosure on file
Claude Hemphill III, MD, FAAN (Zuckerberg San Francisco General Hospital)	Dr. Hemphill has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll. Dr. Hemphill has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for various legal firms. The institution of Dr. Hemphill has received research support from NIH/NINDS.
Tanuja Chitnis, MD, FAAN (Brigham and Women's Hospital)	Dr. Chitnis has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. Dr. Chitnis has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Roche-Genentech. Dr. Chitnis has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Siemens. Dr. Chitnis has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Octave Biosciences. Dr. Chitnis has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi. The institution of Dr. Chitnis has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Chitnis has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Academic CME. The institution of Dr. Chitnis has received research support from Novartis. The institution of Dr. Chitnis has received research support from Sanofi. The institution of Dr. Chitnis has received research support from Octave. The institution of Dr. Chitnis has received research support from Genentech-Roche. The institution of Dr. Chitnis has received research support from Tiziana Life Sciences. The institution of Dr. Chitnis has received research support from Bristol-Myers Squibb. The institution of Dr. Chitnis has received research support from Wesley Clover.

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