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A Triage Model for Interhospital Transfers of Low Risk Intracerebral Hemorrhage Patients.

Publication ,  Journal Article
Kaleem, S; Lutz, MW; Hernandez, CE; Kang, JH; James, ML; Dombrowski, KE; Swisher, CB; VanDerWerf, JD
Published in: J Stroke Cerebrovasc Dis
April 2021

OBJECTIVES: Intracerebral hemorrhage comprises a large proportion of inter-hospital transfers to comprehensive stroke centers from centers without comprehensive stroke center resources despite lack of mortality benefit and low comprehensive stroke center resource utilization. The subset of patients who derive the most benefit from inter-hospital transfers is unclear. Here, we create a triage model to identify patients who can safely avoid transfer to a comprehensive stroke center. MATERIALS AND METHODS: A retrospective cohort of spontaneous intracerebral hemorrhage patients transferred to our comprehensive stroke center from surrounding centers was used. Patients with early discharge from the Neuroscience Intensive Care Unit without use of comprehensive stroke center resources were identified as low risk, non-utilizers. Variables associated with this designation were used to develop and validate a triage model. RESULTS: The development and replication cohorts comprised 358 and 99 patients respectively, of whom 78 (22%) and 26 (26%) were low risk, non-utilizers. Initial Glasgow Coma Scale and baseline hemorrhage volume were associated with low risk, non-utilizers in multivariate analysis. Initial Glasgow Coma Scale >13, intracerebral hemorrhage volume <15ml, absence of intraventricular hemorrhage, and supratentorial location had an area under curve, specificity, and sensitivity of 0.72, 91.4%, 52.6%, respectively, for identifying low risk, non-utilizers, and 0.75, 84.9%, 65.4%, respectively, in the replication cohort. CONCLUSIONS: Spontaneous intracerebral hemorrhage patients with Glasgow Coma Scale >13, intracerebral hemorrhage volume <15 ml, absence of intraventricular hemorrhage, and supratentorial location might safely avoid inter-hospital transfer to a comprehensive stroke center. Validation in a prospective, multicenter cohort is warranted.

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Published In

J Stroke Cerebrovasc Dis

DOI

EISSN

1532-8511

Publication Date

April 2021

Volume

30

Issue

4

Start / End Page

105616

Location

United States

Related Subject Headings

  • Triage
  • Tomography, X-Ray Computed
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Reproducibility of Results
  • Prognosis
  • Predictive Value of Tests
  • Patient Transfer
  • Neurology & Neurosurgery
 

Citation

APA
Chicago
ICMJE
MLA
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Kaleem, S., Lutz, M. W., Hernandez, C. E., Kang, J. H., James, M. L., Dombrowski, K. E., … VanDerWerf, J. D. (2021). A Triage Model for Interhospital Transfers of Low Risk Intracerebral Hemorrhage Patients. J Stroke Cerebrovasc Dis, 30(4), 105616. https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105616
Kaleem, Safa, Michael W. Lutz, Christian E. Hernandez, Jennifer H. Kang, Michael L. James, Keith E. Dombrowski, Christa B. Swisher, and Joshua D. VanDerWerf. “A Triage Model for Interhospital Transfers of Low Risk Intracerebral Hemorrhage Patients.J Stroke Cerebrovasc Dis 30, no. 4 (April 2021): 105616. https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105616.
Kaleem S, Lutz MW, Hernandez CE, Kang JH, James ML, Dombrowski KE, et al. A Triage Model for Interhospital Transfers of Low Risk Intracerebral Hemorrhage Patients. J Stroke Cerebrovasc Dis. 2021 Apr;30(4):105616.
Kaleem, Safa, et al. “A Triage Model for Interhospital Transfers of Low Risk Intracerebral Hemorrhage Patients.J Stroke Cerebrovasc Dis, vol. 30, no. 4, Apr. 2021, p. 105616. Pubmed, doi:10.1016/j.jstrokecerebrovasdis.2021.105616.
Kaleem S, Lutz MW, Hernandez CE, Kang JH, James ML, Dombrowski KE, Swisher CB, VanDerWerf JD. A Triage Model for Interhospital Transfers of Low Risk Intracerebral Hemorrhage Patients. J Stroke Cerebrovasc Dis. 2021 Apr;30(4):105616.
Journal cover image

Published In

J Stroke Cerebrovasc Dis

DOI

EISSN

1532-8511

Publication Date

April 2021

Volume

30

Issue

4

Start / End Page

105616

Location

United States

Related Subject Headings

  • Triage
  • Tomography, X-Ray Computed
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Reproducibility of Results
  • Prognosis
  • Predictive Value of Tests
  • Patient Transfer
  • Neurology & Neurosurgery