Introduction: Intracerebral hemorrhage (ICH) patients are routinely transferred to comprehensive stroke centers (CSCs) for neurosurgical and neurocritical care. We compared transferred (TP) and directly presenting (DP) ICH patients at our CSC, and explore the factors associated with non-utilization of CSC Services (NCS).
Methods: We identified primary ICH patients, admitted between 01/01/2016 and 03/31/2017, from our Stroke Registry. We used logistic regression to compare demographics, disease severity, and outcomes between TP and DP, and report odds ratios (OR) and 95% confidence intervals (CI). We categorized patients who did not stay in the neurocritical care unit and did not undergo neurosurgical procedures (including extra-ventricular drain) as NCS patients. We used receiver operative curve (ROC) analyses to determine the discriminatory potential of routinely used severity scales in identifying NCS patients and report area under the curve (AUC).
Results: We included 958 patients in our analyses. TP had significantly lower disease severity and shorter length of stay. Overall, 33.7% of patients were NCS, and NCS patients were more likely to be TP as compared to DP [OR (CI): 1.60 (1.18-2.16)]. NCS patients also had a significantly lower median National Institutes of Health Stroke Scale (NIHSS) and ICH scores, and higher median Glasgow Coma Scale (GCS) score on presentation (Table 1). All three scales had a fair-good individual discrimination for classifying NCS patients (AUC 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 AUC for all three scales was 0.84 (Figure 1).
Conclusion: 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. Disease severity scales may be helpful in classification of these patients. Further validation studies are warranted.