Abstract Details

Title Establishing Criteria for Triage of Primary Intracerebral Hemorrhage Patients: Optimizing ICH Care Across Health Care Systems

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P2 - Poster Session 2 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-014

Objective Explore factors associated with non-utilization of CSC Services (n-CSC) among primary intracerebral hemorrhage (ICH) patients and provide preliminary criteria for early identification and triage of n-CSC patients.

Background ICH patients are routinely transferred to CSCs for neurosurgical and neurocritical care. However, evidence for utility and criteria of such transfers is lacking.

Design/Methods Primary ICH patients admitted between 01/01/2016 and 03/31/2017 were identified from our stroke registry. Patients who did not stay in the neurocritical care unit, did not get an extra-ventricular drain, or did not undergo a neurosurgical procedure were categorized as n-CSC patients. Logistic regression models were utilized to compare demographics, disease severity, and outcomes between CSC utilizers and n-CSC patients. Odds ratios (OR) and 95% confidence intervals (CI) are reported. Receiver operative curve (ROC) analyses were used to determine the discriminatory potential of routinely used severity scales in identifying n-CSC patients.

Results A total of 958 patients were included, among whom 33.7% were n-CSC. Transferred patients were more like to be n-CSC as compared to those who directly presented to CSC (OR, CI: 1.60,1.18-2.16). N-CSC patients had a significantly lower median NIH Stroke Scale (NIHSS) and ICH scores, and higher median Glasgow Coma Scale (GCS) score on presentation. All three scales had a fair to good individual discrimination for classifying n-CSC patients (c-statistic for GCS, NIHSS, ICH Score: 0.71, 0.77, and 0.80 respectively). After dichotomizing GCS at 10 and categorizing NIHSS at 0-5 / 6-15 / 16+, the combined c-statistic for all three scales was 0.84.

Conclusions A third of ICH patients presenting at CSC do not utilize neurosurgical / neurocritical care. Identification and triage of these patients may help optimize ICH care and provide criteria for randomization of ICH patients across various levels of care in a health-care system. Further validation in external cohorts is needed.

Authors/Disclosures
Katie Alex (University of Texas Health Science Center At Houston) PRESENTER	No disclosure on file
Jennifer Meeks	No disclosure on file
	No disclosure on file
Sunil Sheth, MD (University of Texas At Houston)	Dr. Sheth has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Penumbra. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerenovus. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Imperative Care.
Sean I. Savitz, MD	Dr. Savitz has nothing to disclose.
Farhaan S. Vahidy, MBBS, PhD (Houston Methodist)	Dr. Vahidy has nothing to disclose.

��ɫ��

��ɫ��