Triage of Patients with Intracerebral Hemorrhage to Comprehensive Versus Primary Stroke Centers

Patel, Nikhil; Tran, Quincy; Capobianco, Paul; Traynor, Timothy; Armahizer, Michael; Motta, Melissa; Parikh, Gunjan; Badjatia, Neeraj; Chang, Wan‐Tsu W.; Morris, Nicholas

doi:10.1016/j.jstrokecerebrovasdis.2021.105672

Cited by 5 publications

(6 citation statements)

References 38 publications

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“…The use of CT angiograms to identify arteriovenous malformations supports the notion that most ICHs can be correctly classified as primary vs secondary at presentation by history and imaging. We agree with Patel et al 1 to include only information available at presentation; notably, their score contains previous antiplatelet use, which is commonly unknown or uncertain at presentation. 3…”

supporting

confidence: 63%

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Author Response: Novel Score for Stratifying Risk of Critical Care Needs in Patients With Intracerebral Hemorrhage

Faigle¹,

Gottesman²

2021

Neurology

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We complement the authors for their rigorous development of an ICU triage score for patients with intracerebral hemorrhage (ICH), including external validation methods. 1 However, we do have concerns about their methodology.The study only included patients with primary ICH, which is frequently unknown at presentation and diagnosed after admission. We believe that an ICU triage scoring system should only include information available at presentation, not information obtained after admission. We derived an ICH triage score which includes all patients with ICH and found that the presence of definite arteriovenous malformation on the CT angiogram at presentation can provide valuable information for triage. 2

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supporting

confidence: 63%

“…We thank Patel et al 1 for their interest in our study 2 and congratulate them on theirs. However, we disagree with their assertions.…”

mentioning

confidence: 89%

Author Response: Novel Score for Stratifying Risk of Critical Care Needs in Patients With Intracerebral Hemorrhage

Faigle¹,

Gottesman²

2021

Neurology

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“…Some use subitems of the ICH Score, which rely on information obtained after acute imaging. 20,21 Patel et al 20 additionally described prior antiplatelet treatment as a risk factor for needing surgery. To utilize CSC and prehospital resources efficiently, it is important to identify patients in need of CSC care as early as possible and avoid unnecessary interhospital transfer.…”

Section: Discussionmentioning

confidence: 99%

Impact of prehospital stroke triage implementation on patients with intracerebral hemorrhage

Almqvist

Delgado

Sjöstrand

et al. 2023

Ther Adv Neurol Disord

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Background: Little is known about how prehospital triage using large vessel occlusion (LVO) stroke prediction scales affects patients with intracerebral hemorrhage (ICH). Objectives: We aimed to investigate whether the Stockholm Stroke Triage System (SSTS) implemented in 2017 has affected timing and outcomes of acute ICH neurosurgery, and to assess system triage accuracy for ICH with a neurosurgical indication or LVO thrombectomy. Design: Observational cohort study. Methods: In the Stockholm Region, we compared surgical timing, functional outcome, and death at 3 months in patients transported by code-stroke ground ambulance who had ICH neurosurgery, 2 years before versus 2 years after SSTS implementation. We also calculated triage precision metrics for treatment with either ICH neurosurgery or thrombectomy. Results: A total of 36 patients undergoing ICH neurosurgery were included before SSTS implementation and 30 after. No significant difference was found in timing of neurosurgery [median 7.5 (4.9–20.7) versus 9.1 (6.1–12.5) h after onset], distribution of functional outcomes (median 4 versus 4), and death at 3 months [3/29 (9%) versus 5/35 (17%)] before versus after implementation, respectively. The SSTS routed a larger proportion of patients subsequently undergoing ICH neurosurgery directly to the comprehensive stroke center: 13/36 (36%) before versus 18/30 (60%) after implementation. Overall system triage accuracy for ICH neurosurgery or thrombectomy was high at 90%, with 92% specificity and 65% sensitivity. Conclusion: The SSTS, initially designed for prehospital LVO stroke triage, routed more patients with neurosurgical indication for ICH directly to the comprehensive stroke center. This did not significantly affect surgical timing or outcomes.

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“…Age, GCS on admission, the haematoma location, haematoma volume, and intraventricular expansion were previously described parameters strongly associated with neurologic deterioration. 16 , 17 These parameters, not individually but all together, help to predict the outcomes of SICH patients. Additionally, radiologic findings guide the treatment, for example, a possible need for surgery.…”

Section: Discussionmentioning

confidence: 99%

Estimating the Outcomes of Intracerebral Haemorrhage with Intracerebral Haemorrhage Score and Acute Physiology and Chronic Health Evaluation-II Score: A Multicentre Study

Gürbüz¹,

Topçu²

2022

Turk J Anaesthesiol Reanim

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Objective: Spontaneous intracerebral haemorrhage causes mortality or leads to permanent disability in most of the survivors. Thus, determining the severity of the disease to predict mortality and morbidity is important. This study aimed to evaluate Acute Physiology and Chronic Health Evaluation-II and Intracerebral Haemorrhage scores in spontaneous intracerebral haemorrhage patients treated in intensive care units. Methods: This multicenter study was conducted in 2 tertiary care hospitals’ general intensive care units. Short- (in-hospital) and long-term (1-year) mortality and functional outcomes at discharge were evaluated using the Intracerebral Haemorrhage and Acute Physiology and Chronic Health Evaluation-II scores. Results: Of the 35 spontaneous intracerebral haemorrhage patients analysed, the modified Ranking Scale was <4 in 10 (28.6%) patients and ≥4 in 25 (71.4%) patients. The in-hospital mortality was 51.4%, and 1-year mortality was 60%. The discriminative power of Acute Physiology and Chronic Health Evaluation-II was excellent (area under the curve ≥0.9), and Intracerebral Haemorrhage Score was fair (area under the curve ≥0.7) for both in-hospital mortality and poor outcomes at discharge. The area under the curve of Acute Physiology and Chronic Health Evaluation-II was significantly higher than the area under the curve of Intracerebral Haemorrhage score. Conclusion: Acute Physiology and Chronic Health Evaluation-II score is a better model with high sensitivity and specificity than the Intracerebral Haemorrhage score in predicting the in-hospital mortality and functional outcomes at the discharge of spontaneous intracerebral haemorrhage patients. However, the Acute Physiology and Chronic Health Evaluation-II score lacks the neuroradiologic features that are crucial for spontaneous intracerebral haemorrhage. Therefore, the Intracerebral Haemorrhage score can be used as an indicator of neurological status combined with the Acute Physiology and Chronic Health Evaluation-II score rather than as a predictive model of outcomes.

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Triage of Patients with Intracerebral Hemorrhage to Comprehensive Versus Primary Stroke Centers

Cited by 5 publications

References 38 publications

Author Response: Novel Score for Stratifying Risk of Critical Care Needs in Patients With Intracerebral Hemorrhage

Author Response: Novel Score for Stratifying Risk of Critical Care Needs in Patients With Intracerebral Hemorrhage

Impact of prehospital stroke triage implementation on patients with intracerebral hemorrhage

Estimating the Outcomes of Intracerebral Haemorrhage with Intracerebral Haemorrhage Score and Acute Physiology and Chronic Health Evaluation-II Score: A Multicentre Study

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