Abstract
Background The mortality rate for spontaneous intracerebral haemorrhage (ICH) has remained high and stable for many years. The unfavourable prognostic factors include age, bleeding volume, location of the haematoma, high blood pressure, and disturbed consciousness on admission. Other risk factors associated with medical care also deserve attention. The study aimed to analyse the relationship between day of admission, concerning other prognostic factors, and short-term mortality in ICH, in a Polish specialist stroke unit. Methods Medical records of 156 patients (74 males, 82 females, mean age 68.7 years) diagnosed with spontaneous ICH and admitted to a specialist stroke center were retrospectively analysed. Demographics, location, volume of bleeding, blood pressure values, and the Glasgow Coma Scale (GCS), as well as the day of admission, were determined. The relationships were analysed between these factors and 30-day mortality in the patients with ICH. Results A total of 83 patients were admitted to the hospital during weekdays (Monday 8 am to Friday 3 pm) and 73 during weekends or holidays. Of these, 65 patients died within 30 days. Patients admitted at weekends initially presented with lower GCS scores. Admission on Saturday was associated with an increased risk of death (OR 3.38, 95% CI 1.2–9.48, p < 0.05), but after correction for clinical state measured with the GCS and ICH score, the association was no longer significant. Conclusions The time and mode of admission were not associated with increased risk of short-term mortality in ICH patients. Prehospital care issues should be additionally considered as prognostic factors of the outcome.
Highlights
Intracerebral haemorrhage (ICH) occurs with an incidence of 41–47 per 100,000 adult population of Poland, which means that it makes up almost 13–17% of stroke cases registered in the country
Out of the 156 patients admitted with a diagnosis of spontaneous intracranial haemorrhage, 65 died within 30 days, with an early mortality rate of 41.6%
Out of the156 patients, 14 (9%) had their ICH evacuated in the neurosurgical department during the first 48 hours (78% of them died within 30 days), 19 patients were transferred directly to the intensive care unit (ICU) (57% died), and 127 patients were treated in the neurological department (28.3% died)
Summary
Intracerebral haemorrhage (ICH) occurs with an incidence of 41–47 per 100,000 adult population of Poland, which means that it makes up almost 13–17% of stroke cases registered in the country. E DNR recommendation, a written instruction from a physician to all healthcare providers not to perform cardiopulmonary resuscitation, based on the clinical and radiographic predictors strongly affects the intensity of care and range of therapeutic interventions for a critically ill patient. In such cases, the phenomenon of self-fulfilling prophecy may occur, especially when the DNR. Many authors point out that the degree of reference of the stroke center may have an impact on mortality due to provided level of specialist interventions and care [17, 18]; they stress the importance of tertiary reference or municipal teaching centers in reducing the risk of death in the course of ICH in the last decade
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