Abstract TMP17: Predicting Neurosurgical Intervention After Intracerebral Hemorrhage (ICH) Transfer

Abstract

This is a retrospective chart review to ascertain the rates of neurosurgical intervention following transfer of patients with non-traumatic intracerebral hemorrhage (ICH) to a Comprehensive Stroke Center (CSC) and characterize predictors of need for surgical intervention. Introduction: While neurosurgical intervention is required in a minority of cases, it has become standard practice for all ICH patients to be transferred to our tertiary care center, without consideration of additional factors. This creates significant burden and stress to patients and families as well as hospital resources. Hypothesis: We hypothesize that only a minority of ICH patients require neurosurgical intervention and that we will be able to identify predictors that will assist in identifying patients who are at risk for needing neurosurgical intervention. Methods: We retrospectively reviewed the EMR from all ICH patients transferred to a 700-bed CSC from 2020-2023. We collected: age, sex, pre-stroke modified Rankin score, ICH score, BP management, anticoagulant reversal, any neurosurgical intervention performed, length of stay (LOS), and 30-day mortality. The data was stored and analyzed in a secure online database. Results: Of the 420 completed charts, 55% of patients were male with an average age of 67.7 years. Only 14.25% (61/420) of all patients underwent neurosurgical intervention. Predictors for surgery included: age (average age of patients who underwent surgery was 61.2 years); size and location of the hematoma (the majority of patients who underwent surgery (58/61) had ICH volume >30cc, were subtentorial in location, or had IVH extension); higher ICH score (23.96% with ICH ≥2 vs. 6.67% with ICH 0-1); and lower GCS (41.5% GCS <12 vs. 9.8% GCS ≥ 12). Average hospital length of stay was 10.5 days. Mortality rate at 30-days was 24.5% overall and higher in patients who underwent neurosurgical intervention (32.8%). Conclusion: Only a small percentage of patients with ICH transferred to our CSC require neurosurgical intervention. There are many predictive factors allowing for a more thoughtful approach to better utilize health care resources. We recommend further studies to develop better strategies to triage these patients.