766 Hematoma expansion in patients with spontaneous intracranial hemorrhage: Role of emergency department transfer
Recommended Citation
Khairy M, Hawatian K, Bradley T, Rao A, Booher TR, Haupfear I, Dercon S, Zetuna S, Attisha T, Mcclain-Gierach S, Khalil F, Page B, Gunaga S, Miller J, Karmo B. 766 Hematoma expansion in patients with spontaneous intracranial hemorrhage: Role of emergency department transfer. Acad Emerg Med 2024; 31(S1):339.
Document Type
Conference Proceeding
Publication Date
4-27-2024
Publication Title
Acad Emerg Med
Abstract
Background and Objectives: Patients with spontaneous intracranial hemorrhage (sICH) have high mortality and frequently require transfer to a Comprehensive Stroke Center (CSC). The transfer process can delay critical aspects of guideline-based care. Our objective was to measure the association of ED transfer with hematoma expansion in patients with sICH. Methods: This was an observational study analysing the Get with the Guidelines Stroke Registry from large CSC receiving transfers across southeast Michigan. We analysed data from 2019 to 2023 of all sICH adults admitted to the CSC, excluding those with traumatic etiology. Transfer patients were defined as those sent to the CSC from a separate ED. Investigators calculated hematoma volume for presenting and 24-h CT images using the ABC/2 formula. The registry also included validated ICH score data, incorporating age, ICH volume, intraventricular extension, and anatomical location. The primary outcome was hematoma expansion, defined by any increase in hematoma volume from baseline. Analysis included descriptive statistics and multivariable logistic regression. Results: We included 333 patients with spontaneous ICH. The mean age was 62.1?±?15.2?years, 179 (53.8%) presenting directly to a CSC and 154 (46.3%) requiring transport to the CSC. The overall cohort had 161 (48.4%) females, 177 (53.2%) African Americans, and 105 (31.5%) Caucasians. There were 52 (34.0%) patients on anticoagulation: 27 (51.9%) in the non-transfer cohort and 25 (48.1%) in the transfer cohort. Among the 52 patients on anticoagulation, 33 (63.5%) were on direct oral anticoagulants (DOAC). Mortality was similar in both groups: 31 (17.3%) patients in the non-transfer cohort and 25 (16.2%) in the transfer cohort (p?=?0.79). Hematoma expansion was present in 51 (15.4%) patients: 11 (6.1%) in the non-transfer cohort and 40 (25.9%) in the transfer cohort. Adjusting for baseline ICH score and use of a DOAC, transfer patients had significantly higher odds of hematoma expansion compared to non-transfer patients (odds ratio 5.1, 95% CI 2.5–10.3, p?
Volume
31
Issue
S1
First Page
339
