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Abstract Details

Code ICH: Identifying Factors Delaying Timely Diagnosis and Treatment of Intracerebral Hemorrhage (ICH)
Cerebrovascular Disease and Interventional Neurology
P5 - Poster Session 5 (8:00 AM-9:00 AM)
13-006

To identify patient-related, provider-related, and clinical factors that delay the timely diagnosis and treatment of ICH. 

Many intracerebral hemorrhage (ICH) patients fail to meet Get With the Guidelines (GWTG) and American Heart Association (AHA) diagnostic and therapeutic time targets.

We conducted a retrospective study of consecutive non-traumatic ICH patients admitted at three comprehensive stroke centers between 4/1/2023-6/30/2024. Inclusion criteria were direct admission through the emergency department (ED), stroke code activation, and requirement of antihypertensive treatment due to systolic blood pressure (SBP) >150 mmHg and/or anticoagulant use requiring reversal. Transfers, inpatient strokes, and those with last known normal (LKN)-to-door >24 hours were excluded.  Demographic factors, team structure, clinical presentation, and ED complications were evaluated as predictors of meeting GWTG/AHA time targets including door-to-CT scan ≤25 minutes, door-to-BP-medication ≤60 minutes, and door-to-anticoagulant-reversal ≤90 minutes using stepwise backward multivariate regression analysis. 

We identified 130 patients (median age 69 [IQR 53-77], 45% female, 45% white, 29% non-English speaking). Median LKN-to-door time was 148 (IQR 65-442) minutes. Door-to-CT ≤25 minutes occurred in 75.4%, door-to-BP-medication ≤60 minutes in 63.9%, door-to-anticoagulant-reversal ≤90 minutes in 63.6%. Significant univariate predictors of delayed door-to-CT were: non-white race (OR 4.032, 95%CI 1.597-10.204), non-English speaking (OR 3.455, 95%CI 1.492-8.001), ED walk-in (OR 6.200, 2.208-17.407), non-focal neurological deficit (OR 3.531, 95%CI 1.335-9.341), and intubation (OR 4.882, 95%CI 2.014-11.838). Fewer women met door-to-BP-medication goals (OR 2.603, 95%CI 1.111-6.099) and fewer non-English-speaking patients met door-to-anticoagulant-reversal (OR 13.000, 95%CI 1.109-152.351) (all P<0.05). Multivariate analysis demonstrated increased door-to-CT-times in non-white patients (OR 5.154, 95%CI 1.324-20.000, P=0.018), walk-ins (OR 3.841, 95%CI 1.232-11.972, P=0.020), patients with lower NIHSS (OR 1.085, 95%CI 1.004-1.174, P=0.039), and intubations (OR 11.617, 95%CI 2.437-55.375, P=0.002). No significant multivariate delay factor was found for door-to-treatment-times.

Non-white patients, walk-ins, those with lower NIHSS, and those requiring intubation were more likely to experience delays in ICH care.

Authors/Disclosures
Sean Hanna, MD (NYU)
PRESENTER 		Dr. Hanna has nothing to disclose.
Melanie Li, MD Dr. Li has nothing to disclose.
Hanna Vinitsky, DO Dr. Vinitsky has nothing to disclose.
Bavica Gummadi, DO (NYU Langone) Dr. Gummadi has nothing to disclose.
Joanna Marmo (NYU Langone Health) Joanna Marmo has nothing to disclose.
Laura M. Ades, MD (NYU Langone) Dr. Ades has nothing to disclose.
Benjamin Brush, MD (NYU Langone Neurology) Dr. Brush has nothing to disclose.
Leah P. Dickstein, MD (Johns Hopkins Hospital) Dr. Dickstein has nothing to disclose.
Brandon Giglio, MD (NYU Langone Medical Center) Dr. Giglio has nothing to disclose.
Denise Grueneberg, RN Mrs. Grueneberg has nothing to disclose.
Koto Ishida, MD, FAAN (NYU) Dr. Ishida has received publishing royalties from a publication relating to health care.
David E. Kahn, MD (NYU School of Medicine) An immediate family member of Dr. Kahn has received personal compensation for serving as an employee of Essai.
Ariane Lewis, MD, FAAN (NYU Langone Medical Center) Dr. Lewis has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Seminars in Neurology. Dr. Lewis has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of Clinical Neuroscience.
Aaron Lord, MD (NYU Langone-Brooklyn) Dr. Lord has nothing to disclose.
Kara R. Melmed, MD (NYU Langone Neurology Associates) Dr. Melmed has nothing to disclose.
Nirmala Raghunath, RN Mrs. Raghunath has nothing to disclose.
Matthew D. Sanger, MD Dr. Sanger has nothing to disclose.
Jose L. Torres, MD (NYU) Dr. Torres has nothing to disclose.
Marianne Turndahl, DNP Ms. Turndahl has nothing to disclose.
Ting Zhou, MD (New York University Langone Health - Brooklyn) Dr. Zhou has nothing to disclose.
Jennifer A. Frontera, MD (NYU Langone Health) Dr. Frontera has received personal compensation in the range of $500-$4,999 for serving as a Consultant for FirstKindMedical. Dr. Frontera has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Physician 好色先生 Resource. The institution of Dr. Frontera has received research support from NIH. The institution of Dr. Frontera has received research support from Alexion. Dr. Frontera has received publishing royalties from a publication relating to health care.