Abstract Details

Title Expansion of Intracerebral Hemorrhage during Transfer to a Tertiary Referral Center

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P02 - (-)

Poster/Presentation
Number 014

Objective

Background BACKGROUND: As a tertiary stroke center, we have increased our outreach efforts to hospitals in the greater metropolitan region, having a policy to accept all patients with ICH. Proposed Comprehensive Stroke Center guidelines mandate receipt of these patients for higher level of care. We assessed the rate of ICH expansion in patients transferred vs directly admitted to our center. We hypothesized that patients accepted from outside hospitals would have higher rates of hematoma expansion.

Design/Methods DESIGN/METHODS: From our prospectively-collected stroke registry, we reviewed all spontaneous, primary ICH patients from 3/2011-3/2012. All ICH volumes were measured by ABCD2 criteria. Patients were included who had repeat imaging within 4-24 hours. Primary outcome was the percentage of patients with at least 30% increase in ICH volume.

Results RESULTS: We identified 223 patients; 128 (57 %) were transfer patients; 70 out of 223 patients had expansion (47 out of 70 were transfers. The odds of being a transfer patient were significantly higher (OR of 1.81, 1.005-3.28) among those with hematoma expansion. There was no significant difference in age (65 vs 64), platelets (213 vs 201) , PTT (29.9) vs (29.0). After controlling for other factors, independent predictors for ICH expansion were admission INR (OR 1.68 (95% CI 0.98-2.86), admission glucose OR 0.99(0.98-0.99), brainstem location OR 4.98(1.003-24.81) and transfer OR 2.02 (1.09 - 3.74).

Conclusions CONCLUSIONS: ICH expansion occurred more commonly in patients transferred to our center. Our results raise the need to institute more aggressive measures for transfer patients en route to our center in order to prevent ICH hematoma expansion.

Authors/Disclosures
Osman Mir, MD (Texas Stroke Institute) PRESENTER	No disclosure on file
Claude Nguyen, MD (Current Neurology Solutions)	Dr. Nguyen has nothing to disclose.
Waldo Guerrero, MD	Dr. Guerrero has nothing to disclose.
Farhaan S. Vahidy, MBBS, PhD (Houston Methodist)	Dr. Vahidy has nothing to disclose.
Sean I. Savitz, MD	Dr. Savitz has nothing to disclose.
Tracy T. Batchelor, MD, MPH (Brigham and Women's Hospital)	Dr. Batchelor has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Up To Date, Inc. An immediate family member of Dr. Batchelor has received publishing royalties from a publication relating to health care. Dr. Batchelor has received publishing royalties from a publication relating to health care.

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