The association between on-scene blood pressure and early neurological deterioration in patients with spontaneous intracerebral haemorrhage

Fan, Ju-Sing; Chen, Yen-Chia; How, Chorng–Kuang; Yen, David Hung-Tsang; Huang, Mu-Shun

doi:10.1136/emermed-2013-203114

Cited by 27 publications

(38 citation statements)

References 29 publications

(24 reference statements)

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“…Many studies have mentioned that extremely high blood pressure was related to early haematoma enlargement and led to poor prognosis 2 9 18–20. Unfortunately, so far the optimal range of blood pressure in the early stage has not been established 2 18 19.…”

Section: Discussionmentioning

confidence: 99%

“…The current prospective cohort study was conducted in the emergency department (ED) of Taipei General Veterans Hospital (TVGH), a 3000-bed tertiary referral centre that treats more than 200 SICH cases each year in a protocol-based manner 8 9. From 1 July 2011 to 30 June 2015, consecutive non-comatose (Glasgow Coma Scale [GCS] score >12) adult patients with first-ever SICH prepared to transfer to our ED by ambulance were enrolled as eligible participants at the time of first telephone contact.…”

Section: Methodsmentioning

confidence: 99%

“…Normally, an experienced ED nurse practitioner or emergency physician with a nurse practitioner would accompany the patient during ambulance transportation. In our ED, the treatment plans for referral of SICH cases are protocolised 8 9. We keep stabilising the patient's airway, breathing and circulation after the patient's arrival.…”

Section: Methodsmentioning

confidence: 99%

“…However, recent studies had reported delays in optimising care before and during transfer, which may potentially lead to neurological deterioration during the peritransfer period and therefore might cause poorer neurological outcome 4 7. Moreover, a substantial percentage of patients with SICH suffer from haematoma expansion during the first few hours following the onset of symptoms, causing a rapid decline in the condition of such patients 2 5 8 9. Knowing which patients are at higher risk for interhospital transfer neurological deterioration (IHTND) helps the treating emergency physician determine the benefit and risk of transfer, to make decisions about the level of accompanying personnel and ambulance equipment, and to allow the receiving hospital to be well prepared early, which might translate to better prognosis.…”

Section: Introductionmentioning

confidence: 99%

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Interhospital transfer neurological deterioration in patients with spontaneous intracerebral haemorrhage: incidence and risk factors

Fan

Chen

Yen

et al. 2016

Postgraduate Medical Journal

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Interhospital transfer neurological deterioration in patients with spontaneous intracerebral haemorrhage: incidence and risk factors

Fan

Chen

Yen

et al. 2016

Postgraduate Medical Journal

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“…H igh blood pressure (BP) is common in patients with spontaneous intracerebral hemorrhage (ICH) 1,2 and predicts a poor outcome, [3][4][5][6][7] but data have been conflicting on the effects of BP lowering treatment. Some studies have implied adverse effects from reducing systolic BP (SBP), [8][9][10] whereas others have indicated clinical improvement with higher SBP reduction [11][12][13][14] or no benefits at all of such treatment in ICH.…”

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confidence: 99%

Magnitude of Blood Pressure Reduction and Clinical Outcomes in Acute Intracerebral Hemorrhage

et al. 2015

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Abstract-Evidence supports early intensive blood pressure (BP) lowering in acute intracerebral hemorrhage, but uncertainty persists over whether potential benefits and harms vary according to the magnitude of BP reduction. We aimed to determine whether larger systolic BP (SBP) reductions were associated with better outcomes in participants of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2). INTERACT2 was an international, open, blinded end point, randomized controlled trial of patients with spontaneous intracerebral hemorrhage (<6 hours) and elevated SBP (150-220 mm Hg) assigned to intensive (target SBP <140 mm Hg) or guideline-recommended (SBP <180 mm Hg) treatment. Associations of BP reduction (baseline minus average of achieved SBP) during 3 time periods post randomization (15-60 minutes, 1-24 hours, and 2-7 days) on poor outcome (death or major disability) at 90 days were analyzed in multivariable logistic regression models with odds ratios and 95% confidence intervals. Larger SBP reductions within the first hour after randomization were associated with lower risks of poor outcome: compared with minimal reduction (<10 mm Hg), odds ratios were 0.80 (95% confidence interval, 0.63-1.02) for moderate (10-20 mm Hg) and 0.65 (0.52-0.82) for large (≥20 mm Hg) reductions (P trend <0.01). Similar associations were also observed for SBP reductions during 1 to 24 hours (P<0.01) and 2 to 7 days (P 0.02). No heterogeneity in associations for patients above or below baseline SBP 180 mm Hg was reported (P>0.30). Optimal recovery from intracerebral hemorrhage was observed in hypertensive patients who achieved the greatest SBP reductions (≥20 mm Hg) in the first hour and maintained for 7 days. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00716079.

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Frequency, Predictors, and Outcomes of Prehospital and Early Postarrival Neurological Deterioration in Acute Stroke

et al. 2018

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IMPORTANCE Studies of neurological deterioration in stroke have focused on the subacute period, but stroke treatment is increasingly migrating to the prehospital setting, where the neurological course has not been well delineated. OBJECTIVE To describe the frequency, predictors, and outcomes of neurological deterioration among patients in the ultra-early period following ischemic stroke or intracranial hemorrhage. DESIGN, SETTINGS, AND PARTICIPANTS Exploratory analysis of the prehospital, randomized Field Administration of Stroke Therapy-Magnesium (FAST-MAG) Trial conducted from 2005 to 2013 within 315 ambulances and 60 stroke patient receiving hospitals in Southern California. Participants were consecutively enrolled patients with suspected acute stroke who were transported by ambulance within 2 hours of stroke onset. MAIN OUTCOMES AND MEASURES The main outcome was neurological deterioration, defined as a worsening of 2 or more points on the Glasgow Coma Scale (GCS), a level of consciousness scale ranging from 3 to 15, with higher scores indicating more alertness. Imaging outcomes were ischemic or hemorrhagic injury extent identified during the first brain imaging scan. Outcomes at 3 months included global disability level (assessed using the modified Rankin Scale [mRS]; range, 0-6, with higher numbers indicating greater disability) and mortality. RESULTS Among the 1690 patients (99.4%), the mean (SD) age was 69.4 (13.5) years, and 43% were female. Final diagnoses were acute cerebral ischemia in 1237 patients (73.2%), intracranial hemorrhage in 386 patients (22.8%), and neurovascular mimic in 67 patients (4.0%). The median (interquartile range [IQR]) minutes between the last well-known time and GCS assessments were 23 (14-42) minutes for prehospital, 58 (46-79) minutes for ED arrival, and 149 (120-180) minutes for early ED course assessments. From prehospital to early postarrival, ultra-early neurological deterioration (U-END) occurred in 200 of 1690 patients (11.8%), more often among patients with intracranial hemorrhage than among those with acute cerebral ischemia (119 of 386 [30.8%] vs 75 of 1237 [6.1%], P < .001). Patterns of U-END were prehospital U-END without early recovery in 30 of 965 patients (3.1%), stable prehospital course but early ED deterioration in 49 of 965 patients (5.1%), and continuous deterioration in both prehospital and early ED phases in 27 of 965 patients (2.8%). Ultra-early neurological deterioration was associated with worse 3-month outcomes, including increased global disability (mRS score, 4.6 vs 2.4; P < .001), reduced functional independence (mRS score 0-2, 32 of 200 [16.0%] vs 844 of 1490 [56.6%]; P < .001), and increased mortality (87 of 200 [43.5%] vs 176 of 1490 [11.8%]; P < .001). CONCLUSIONS AND RELEVANCE Ultra-early neurological deterioration occurs in 1 in 8 ambulance-transported patients with acute cerebrovascular disease, including 1 in 3 patients with intracranial hemorrhage and 1 in 16 patients with acute cerebral ischemia, and is associated with markedly reduced func...

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The association between on-scene blood pressure and early neurological deterioration in patients with spontaneous intracerebral haemorrhage

Abstract: Few on-scene BP indices were associated with neuroworsening within 24 h after ED arrival in non-comatose SICH patients. Compared with BP measured on ED arrival or admission, on-scene BP had a stronger correlation with END.

Cited by 27 publications

References 29 publications

Interhospital transfer neurological deterioration in patients with spontaneous intracerebral haemorrhage: incidence and risk factors

Interhospital transfer neurological deterioration in patients with spontaneous intracerebral haemorrhage: incidence and risk factors

Magnitude of Blood Pressure Reduction and Clinical Outcomes in Acute Intracerebral Hemorrhage

Frequency, Predictors, and Outcomes of Prehospital and Early Postarrival Neurological Deterioration in Acute Stroke

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