Hospital to Hospital Transfers of Cerebral Hemorrhage: Characteristics of Early Withdrawal of Life-Sustaining Treatment

Krause, Monica; Mandrekar, Jay; Harmsen, William S.; Wijdicks, Eelco F. M.; Hocker, Sara E.

doi:10.1007/s12028-022-01597-x

Cited by 4 publications

(2 citation statements)

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“…The frequency of WLST in our sample was 22,4%. Many previous studies have found these measures independently related to mortality in patients with ICH [8] [9] [10] [11] [12] [13]. This was also the case in the present study.…”

Section: Discussionsupporting

confidence: 90%

Clinical evolution of patients with Intracerebral hemorrhage in relation to the achievement of intensive blood pressure lowering target

Vázquez-Justes,

Paul-Arias

2024

Preprint

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Introduction: Spontaneous intracerebral hemorrhage (ICH) is one of the most disabling forms of stroke. Intensive lowering of blood pressure (BP) has been postulated as one of the therapies that can improve functional outcomes. However, this intensive reduction is not always achieved. We aimed to study the differences between patients in whom intensive BP lowering was achieved during the first 24 h after admission and those in whom this BP lowering was not possible. Methods: We retrospectively reviewed medical charts to obtain information on BP management during the first 24 hours. Our protocol establishes that intensive BP lowering below 140 mmHg of SBP should be pursued. Results: A total of 210 patients were included. In 103, an intensive target BP was achieved. This group of patients had a lower initial NIHSS score and better clinical evolution, with less early neurological deterioration, fewer requirements of antihypertensive treatment, less necessity for surgical evacuation, less withdrawal of life-sustaining therapies (WLST), and lower mortality at three months (all p < 0,05). However, in the multivariable analysis, BP target achievement was not related to mortality, and only NIHSS score (OR 1,010 [CI 95% 1,007 − 1,203], p = 0,034) and WLST (OR 10,816 [CI 95%: 2,768 − 42,270], p < 0,001) remained related. Conclusions: In our study, patients with intensive BP lowering had better clinical outcomes and lower mortality at 3 months. However, this observation could be related to a better clinical situation at the onset of stroke and fewer requirements for antihypertensive treatment. The initial NIHSS score and adoption of WLST were independently associated with mortality at 3 months.

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Section: Discussionsupporting

confidence: 90%

Clinical evolution of patients with Intracerebral hemorrhage in relation to the achievement of intensive blood pressure lowering target

Vázquez-Justes,

Paul-Arias

2024

Preprint

View full text Add to dashboard Cite

show abstract

“…Severity of the neurologic injury, the diagnosis of stroke, level of consciousness, and older age are among the reported factors contributing to the decision of WLST ( 10 , 11 , 13 , 37 ). A GWTG study based on data collected between 2009 and 2013 found the following factors to be associated with early WLST: older age, female sex, white race, Medicaid and self-pay/no insurance, arrival by ambulance, arrival off hours, baseline nonambulatory status, and stroke type ( 12 ).…”

Section: Discussionmentioning

confidence: 99%