Clinical Features Associated with Early Hospital Arrival after Acute Intracerebral Hemorrhage: Challenges for New Trials

Abstract

Background: Early hospital admission followed by correct diagnosis with minimum delay is a prerequisite for successful new interventions in acute intracerebral hemorrhage (ICH). The aim of this study was to evaluate clinical features associated with early hospital arrival in ICH patients and their influence on the outcome. Methods: Data from all patients arriving within 24 h of the ICH onset were prospectively collected at 2 stroke centers in São Paulo, Brazil. The cutoff of 3 h was chosen to select 2 groups: 0–3 h (early) and >3–24 h (late). Results: We identified 91 ICH patients (mean age 57.9 years, 62% men, 63% white) admitted within the first 24 h of symptom onset between March 2004 and April 2005. Systolic blood pressure, mean arterial pressure and pulse pressure were significantly higher in patients arriving within 3 h. Patients that arrived early also had a higher NIHSS score (p = 0.003), a lower Glasgow Coma Score (p = 0.001) and presence of intraventricular hemorrhage (p = 0.02). Lower ICH scores were more frequent in those that arrived late. Fourteen patients showed hematoma enlargement and the majority of them (n = 13) were admitted within the first 3 h from symptom onset (p = 0.01). Patients who arrived within the 3-hour window had a higher 30-day mortality (p = 0.0008) and a worse Rankin score after 6 months (p = 0.001). Conclusions: Treatment decisions in acute ICH may need to establish new combined approaches to maximize the number of eligible patients for early therapy considering the interactions between independent outcome predictors presented at early onset.

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“…Unfortunately, less than one quarter of our patients sought medical attention within 4.5 hours of becoming aware of stroke symptoms. In our study, the only independent predictor of early arrival was stroke severity, an association well established in the literature 10,13 . As in our series, other authors 9,10 found that ambulance transport was associated with early arrival and suggest that arriving by ambulance and stroke severity provide redundant information as patients with near-normal function tend to not call emergency medical services, while patients who do arrive by ambulance are more heterogeneous but overall have more severe functional limitations.…”

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Cilostazol Reduces the Risk of Hemorrhagic Infarction After Administration of Tissue-Type Plasminogen Activator in a Murine Stroke Model

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