Background
There is increasing focus on implementing acute care bundles for selected patients presenting with intracerebral haemorrhage (ICH). Box Hill Hospital has the fastest treatment metrics for acute ischaemic stroke in Australia. We sought to understand the management of patients presenting with intracerebral haemorrhage to our hospital.
Methods
We interrogated the stroke database for patients with ICH from 2020 to 2023. Variables are extracted from hospital electronic medical records.
Results
Records of 367/410 patients were analysed. Median age was 79 (IQR 68-86) with 51% female. 91% of ICHs were spontaneous and the rest traumatic. Modified Rankin scores were 71%, 20% and 9% for 0-2, 3, and 4-5 groupings respectively. 69% had isolated intraparenchymal haemorrhage, followed by combination of bleeds in 17% and 10% with subarachnoid haemorrhage. Decision for palliation was made for 84/367 after imaging on arrival, 56/367 during the admission, with the rest not discussed.
Limiting analysis to those not immediately palliated (130/283), median blood pressure in the first 24 hours was 146/80mmHg (IQR 136-157, 69-90) with a median of 12 measurements (IQR 8-18). Attempts to reverse anticoagulation was made in 9/10, 2/3, and 14/36 in the warfarin, dabigatran and apixaban/rivaroxaban groups respectively. Neurosurgical opinion was sought for 157 (42%) patients. At 6 months, 162/284 were alive with mortality data missing for 54 (18%).
Conclusion
About one quarter of patients presenting with ICH were palliated immediately. The relatively low rates of anticoagulant reversal in those taking a direct oral anticoagulant, compared to warfarin, requires further investigation.