Abstract Number ‐ 252: High Mortality in Patients with Spontaneous Intracerebral Hemorrhage Experiencing Neurological Decline on Mobile Stroke Unit
Introduction Spontaneous intracranial hemorrhage (ICH) is associated with significant morbidity and mortality. Mobile Stroke Unit (MSU) provides a unique opportunity to assess patients in the hyperacute phase of ICH to track outcomes. Methods Methods: We conducted a retrospective review of patients...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-03-01
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| Series: | Stroke: Vascular and Interventional Neurology |
| Online Access: | https://www.ahajournals.org/doi/10.1161/SVIN.03.suppl_1.252 |
| _version_ | 1797803543586930688 |
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| author | Digvijaya Navalkele Srikant Rangaraju Meghana Srinivas Justine Chen Bianca Nemes Nicolas Bianchi Ritvij Bowry Carol Flemming Stephanie Parker James Grotta Michael Frankel |
| author_facet | Digvijaya Navalkele Srikant Rangaraju Meghana Srinivas Justine Chen Bianca Nemes Nicolas Bianchi Ritvij Bowry Carol Flemming Stephanie Parker James Grotta Michael Frankel |
| author_sort | Digvijaya Navalkele |
| collection | DOAJ |
| description | Introduction Spontaneous intracranial hemorrhage (ICH) is associated with significant morbidity and mortality. Mobile Stroke Unit (MSU) provides a unique opportunity to assess patients in the hyperacute phase of ICH to track outcomes. Methods Methods: We conducted a retrospective review of patients with spontaneous ICH diagnosed on two different MSUs in the United States. Patients were divided into three groups based on symptom onset/last known well (LKW): Group 1: 0–1 hours from LKW, Group 2: 1–2 hours from LKW, and Group 3: 2–4 hours from LKW. We compared neurological decline (ND) rates between MSU and Emergency Department (ED) arrival for patients in the three groups. Neurological decline was defined as a decrease in GCS by ≥ 2 points or an increase in NIHSS ≥ 4 points between MSU and ED examination. χ2 test was used to compare the proportion of patients who experience ND between MSU and ED transport. We also assessed and compared pre‐defined factors that could be associated with ND in the three groups. CT scans done on MSU were compared to those done on ED arrival. Results Results: Fifty‐fourpatients met the study criteria. The mean age was 62, and 69% were male. Median MSU NIHSS was 18, and median ED NIHSS was 19. The mean MSU GCS was 14, and ED GCS was 12. The mean hematoma volume on the MSU CT head was 21 cc and 24 cc on the ED CT head. Mean MSU MAP was 136, and MAP on ED arrival was 120. Thirty‐three percent (18/54) of patients experienced ND between MSU and ED transport. Forty percent (n = 10/25) patients in group 1, 22% (n = 4/18) in group 2 and 36%(n = 4/11) in group 3 had ND (chi‐square 0.45). Overall, patients with ND experienced significantly high mortality (OR 5.091, p = 0.029, CI 1.24‐20.78). On univariate analysis, variables significantly associated with ND were MSU NIHSS, hematoma volume, and presence of hydrocephalus on MSU CT scan. No variables were significant to predict ND on multivariate analysis (Hematoma Expansion OR 1.028, CI 0.99‐1.05; Hydrocephalus OR 3.70 CI 0.67‐20.43) Conclusions Conclusion: One‐thirdof ICH patients experience neurological decline between MSU and ED transport within four hours of symptom onset and are at a significantly higher risk of mortality. Higher ND rates are likely due to earlier diagnosis of ICH on MSU. Due to the smaller sample size, we did not find significant variables associated with ND. However, various ways of providing rapid medical and surgical treatment to these patients should be explored in future studies to assess the effect on functional outcomes. |
| first_indexed | 2024-03-13T05:23:30Z |
| format | Article |
| id | doaj.art-96628e8898bc4c6595b5da2066f34c9b |
| institution | Directory Open Access Journal |
| issn | 2694-5746 |
| language | English |
| last_indexed | 2024-03-13T05:23:30Z |
| publishDate | 2023-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Stroke: Vascular and Interventional Neurology |
| spelling | doaj.art-96628e8898bc4c6595b5da2066f34c9b2023-06-15T10:40:48ZengWileyStroke: Vascular and Interventional Neurology2694-57462023-03-013S110.1161/SVIN.03.suppl_1.252Abstract Number ‐ 252: High Mortality in Patients with Spontaneous Intracerebral Hemorrhage Experiencing Neurological Decline on Mobile Stroke UnitDigvijaya Navalkele0Srikant Rangaraju1Meghana Srinivas2Justine Chen3Bianca Nemes4Nicolas Bianchi5Ritvij Bowry6Carol Flemming7Stephanie Parker8James Grotta9Michael Frankel10Emory University Atlanta Georgia United States of AmericaEmory University Atlanta Georgia United States of AmericaProvidence Neuroscience Institute Spokane Washington United States of AmericaUTHealth Houston Texas United States of AmericaUTHealth Houston Texas United States of AmericaEmory University Atlanta Georgia United States of AmericaUTHealth Houston Texas United States of AmericaGrady Memorial Hospital Atlanta Georgia United States of AmericaUTHealth Houston Texas United States of AmericaMemorial Hermann Houston Texas United States of AmericaEmory University Atlanta Georgia United States of AmericaIntroduction Spontaneous intracranial hemorrhage (ICH) is associated with significant morbidity and mortality. Mobile Stroke Unit (MSU) provides a unique opportunity to assess patients in the hyperacute phase of ICH to track outcomes. Methods Methods: We conducted a retrospective review of patients with spontaneous ICH diagnosed on two different MSUs in the United States. Patients were divided into three groups based on symptom onset/last known well (LKW): Group 1: 0–1 hours from LKW, Group 2: 1–2 hours from LKW, and Group 3: 2–4 hours from LKW. We compared neurological decline (ND) rates between MSU and Emergency Department (ED) arrival for patients in the three groups. Neurological decline was defined as a decrease in GCS by ≥ 2 points or an increase in NIHSS ≥ 4 points between MSU and ED examination. χ2 test was used to compare the proportion of patients who experience ND between MSU and ED transport. We also assessed and compared pre‐defined factors that could be associated with ND in the three groups. CT scans done on MSU were compared to those done on ED arrival. Results Results: Fifty‐fourpatients met the study criteria. The mean age was 62, and 69% were male. Median MSU NIHSS was 18, and median ED NIHSS was 19. The mean MSU GCS was 14, and ED GCS was 12. The mean hematoma volume on the MSU CT head was 21 cc and 24 cc on the ED CT head. Mean MSU MAP was 136, and MAP on ED arrival was 120. Thirty‐three percent (18/54) of patients experienced ND between MSU and ED transport. Forty percent (n = 10/25) patients in group 1, 22% (n = 4/18) in group 2 and 36%(n = 4/11) in group 3 had ND (chi‐square 0.45). Overall, patients with ND experienced significantly high mortality (OR 5.091, p = 0.029, CI 1.24‐20.78). On univariate analysis, variables significantly associated with ND were MSU NIHSS, hematoma volume, and presence of hydrocephalus on MSU CT scan. No variables were significant to predict ND on multivariate analysis (Hematoma Expansion OR 1.028, CI 0.99‐1.05; Hydrocephalus OR 3.70 CI 0.67‐20.43) Conclusions Conclusion: One‐thirdof ICH patients experience neurological decline between MSU and ED transport within four hours of symptom onset and are at a significantly higher risk of mortality. Higher ND rates are likely due to earlier diagnosis of ICH on MSU. Due to the smaller sample size, we did not find significant variables associated with ND. However, various ways of providing rapid medical and surgical treatment to these patients should be explored in future studies to assess the effect on functional outcomes.https://www.ahajournals.org/doi/10.1161/SVIN.03.suppl_1.252 |
| spellingShingle | Digvijaya Navalkele Srikant Rangaraju Meghana Srinivas Justine Chen Bianca Nemes Nicolas Bianchi Ritvij Bowry Carol Flemming Stephanie Parker James Grotta Michael Frankel Abstract Number ‐ 252: High Mortality in Patients with Spontaneous Intracerebral Hemorrhage Experiencing Neurological Decline on Mobile Stroke Unit Stroke: Vascular and Interventional Neurology |
| title | Abstract Number ‐ 252: High Mortality in Patients with Spontaneous Intracerebral Hemorrhage Experiencing Neurological Decline on Mobile Stroke Unit |
| title_full | Abstract Number ‐ 252: High Mortality in Patients with Spontaneous Intracerebral Hemorrhage Experiencing Neurological Decline on Mobile Stroke Unit |
| title_fullStr | Abstract Number ‐ 252: High Mortality in Patients with Spontaneous Intracerebral Hemorrhage Experiencing Neurological Decline on Mobile Stroke Unit |
| title_full_unstemmed | Abstract Number ‐ 252: High Mortality in Patients with Spontaneous Intracerebral Hemorrhage Experiencing Neurological Decline on Mobile Stroke Unit |
| title_short | Abstract Number ‐ 252: High Mortality in Patients with Spontaneous Intracerebral Hemorrhage Experiencing Neurological Decline on Mobile Stroke Unit |
| title_sort | abstract number 252 high mortality in patients with spontaneous intracerebral hemorrhage experiencing neurological decline on mobile stroke unit |
| url | https://www.ahajournals.org/doi/10.1161/SVIN.03.suppl_1.252 |
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