Article

Is ED disposition associated with intracerebral hemorrhage mortality?

UC Neuroscience Institute, Cincinnati, OH 45267, USA.
The American journal of emergency medicine (impact factor: 1.54). 05/2011; 29(4):391-5. DOI:10.1016/j.ajem.2009.10.016
Source: PubMed

ABSTRACT Early deterioration is common in intracerebral hemorrhage (ICH). Treatment at tertiary care centers has been associated with lower ICH mortality. Guidelines recommend aggressive care for 24 hours irrespective of the initial outlook. We examined the frequency of and factors associated with transfer to tertiary centers in ICH patients who initially presented at nontertiary emergency departments (EDs). We also compared observed with expected mortality in transferred and nontransferred patients using published short-term mortality predictors for ICH.
Adult patients who resided in a 5-county region and presented to nontertiary EDs with nontraumatic ICH in 2005 were identified. Intracerebral hemorrhage score and ICH Grading Scale (ICH-GS) were determined. Of 16 local hospitals, 2 were designated tertiary care centers. Logistic regression was used to assess factors associated with transfer.
Of 205 ICH patients who presented to nontertiary EDs, 80 (39.0%) were transferred to a tertiary center. In multivariate regression, better baseline function (modified Rankin scale 0-2 versus 3-5; odds ratio, 0.42, 95% confidence interval, 0.21-0.85, P = .016) and black race (odds ratio, 2.28, 95% confidence interval 1.01-5.12, P = .046) were associated with transfer. A trend toward higher 30-day mortality was observed in nontransferred patients (32.5% versus 45.6%, P = .06). The ICH-GS overestimated mortality for all patients, while the ICH Score adequately predicted mortality.
We found no significant difference in mortality between transferred and nontransferred patients, but the trend toward higher mortality in nontransferred patients suggests that further evaluation of ED disposition decisions for ICH patients is warranted. Expected ICH mortality may be overestimated by published tools.

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Keywords

205 ICH patients
 
95% confidence interval
 
Adult patients
 
higher 30-day mortality
 
higher mortality
 
ICH Grading Scale
 
ICH mortality
 
ICH patients
 
ICH Score
 
ICH-GS overestimated mortality
 
intracerebral hemorrhage
 
Intracerebral hemorrhage score
 
Logistic regression
 
lower ICH mortality
 
multivariate regression
 
nontransferred patients
 
nontraumatic ICH
 
short-term mortality predictors
 
tertiary care centers
 
tertiary centers